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R690  .W37  1 91 7     Medicine  as  a  profes 


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C<jl>yri(jlit    Ci.    V.    fhiih   from    Uiulcrtvood    c'r    Uudeitvood,    N.     Y. 
Sll«il()\-f  il-AKK  \l,    W.    C.    GOHGAS,    U.    S      AkMY 


MEDICINE  AS  A  PROFESSION 


DANIEL  W.  WEAVER,  M.D. 

PUBLIC    HEALTH    MEDICAL  OFFICER,  PENSION  EXAMINING  SURGEON,  MEMBER    OP 

THE  INTERNATIONAL  SCHOOL  HYGIENE  ASSOCIATION,  MEMBER  OF 

THE  ILLUMINATING  ENGINEERING  SOCIETY,  ETC. 

AND 

E.  W.  WEAVER,  Pd.M. 

VOCATIONAL  ADVISER  TO  THE  STUDENTS  OP  THE  BROOKLYN  BOYS'  HIGH  SCHOOL, 

SECRETARY    OP    THE    BROOKLYN   VOCATIONAL    GUIDANCE    ASSOCIATION, 

AUTHOR    OF    PROFITABLE    VOCATIONS    FOR    BOYS,  PROFITABLE 

VOCATIONS  FOR  GIRLS,  ETC. 


NEW  YORK  AND  CHICAGO 
THE  A.  S.  BARNES  COMPANY 


IV57 

1 9 17 


Copyright,  1917,  bt 
E.  W.  WEAVER 


PRESS  OF 

THE  NEW  ERA  PRINTING  COMPANY 

LANCASTER,  PA, 


^ 


t 


The  final  proofs  of  this  book  were  completed  on  November 

^th,  IQ17.     Shortly  after  midnight  on  the 

morning  of  that  day 

Xutber  ©berlin  XKIleaver 

aged  18  years,  7  months,  24  days,  a  graduate  of  the 
Brooklyn  Boys^  High  School, 

who  had  assisted  in  collecting  material  for  these  pages, 
was  sent  at  the  time  of  the  destruction  of  the  U.  S. 
patrol  boat  Alcedo  by  a  German  submarine,  to  his  last 
sleep  in  an  unmarked  grave  somewhere  in  the  broad 
Atlantic  far  from  the  quiet  churchyard  where  rest  the 
ten  generations  of  descendants  of  his  German  ancestors 
who  took  refuge  from  oppression  in  the  American  wild- 
erness. By  his  enlistment  at  the  outbreak  of  the  war, 
he  was  compelled  to  decline  a  prof  erred  college  scholar- 
ship because,  as  he  expressed  it,  ''^my  obligations  to  my 
country  must  be  put  before  my  claims  to  her  bounty y 
To  his  memory  this  book  is  dedicated  and  with  this 
dedication  the  hope  is  expressed  that  whether  in  peaceful 
pursuits  or  dangers  of  war,  the  coming  generations  to 
whom  are  accorded  the  generous  benefits  of  our  public 
schools  and  colleges  will  give  themselves  as  unselfishly  to 
the  service  of  humanity  as  did  this  young  man  and  his 
twenty  associates  who  sacrificed  themselves  in  their  efforts 
to  make  the  world  safer  for  democracy. 


t 


^ 


INTRODUCTION 

Approximately  250,000  young  people  are  graduated 
from  our  secondary  schools  every  year,  many  of  whom 
have  ambitions  to  take  up  professional  careers.  With 
the  increased  cost  of  preparation  for  such  careers,  they 
are  called  upon  to  risk  much  upon  a  single  decision. 
They  are  familiar  with  the  status  of  the  physician,  the 
work  of  the  teacher  and  the  rewards  of  the  clergyman. 
The  pay  of  the  teacher  and  the  remuneration  of  the 
minister  are  matters  of  common  knowledge.  The  ex- 
pense of  preparation  for  these  lines  of  service  is  not  so 
great  because  of  the  subsidized  training  facilities  and 
the  availability  of  scholarships.  It  is  not  so  easy  to 
answer  the  inquiries  of  those  who  are  considering  the 
choice  of  medicine  as  a  profession. 

To  find  a  safe  method  of  handling  these  inquirers,  the 
writer  who  had  for  a  number  of  years  been  the  voca- 
tional adviser  to  the  students  of  one  of  our  large  sec- 
ondary schools  undertook  to  enlist  a  number  of  former 
students  who  had  established  themselves  in  this  pro- 
fession to  act  as  volunteer  consultants.  It  was  soon 
found  that  physicians,  like  men  engaged  in  other  call- 
ings, in  comparing  their  achievements  with  the  dreams 
of  their  youthful  days,  believed  that  every  man's  calling 
was  to  be  preferred  to  their  own  and  their  pessimism 
seemed  to  chill  unduly  the  ardor  of  the  youthful  aspi- 
rants. A  collection  of  the  professional  records  of  young 
men  of  known  abilities  was  then  made  and  an  effort  was 
made  to  discover  some  sound  principles  of  vocational 
guidance  from  these  records. 


vi  iNTRODUCTIOlSr. 

The  greater  number  of  boys  who  grew  up  in  a  large 
city  began  their  practice  in  the  cities  of  their  own  sec- 
tion. It  seemed  desirable  for  purposes  of  comparison 
to  have  an  equal  number  of  records  of  those  who  had 
made  places  for  themselves  in  smaller  towns  and  cities 
and  in  other  sections  of  the  country. 

I  turned  to  my  brother,  who,  after  fifteen  years  of 
successful  general  practice  and  active  identification 
with  a  progressive  state  medical  association,  of  which 
for  a  time  he  had  been  president,  at  the  time  was  so- 
journing in  European  medical  centers  for  the  purpose 
of  study  along  some  special  lines  in  which  he  was  inter- 
ested. I  wanted  to  know  how  the  early  life  histories  of 
physicians  could  most  profitably  be  studied  for  the  pur- 
poses which  I  had  in  mind.  He  replied  that  the  way  to 
study  physicians  is  to  isolate  them  and  to  study  them 
the  way  that  they  themselves  studied  germs  and  mi- 
crobes, that  he  had  learned  more  about  the  hopes  and 
aspirations  and  the  shortcomings  of  American  physi- 
cians in  Europe  than  he  did  by  associating  with  them 
at  home,  that  these  men  who  represented  every  section 
of  our  country  talked  more  freely  about  themselves  and 
their  work  in  the  dining  rooms  of  European  caravan- 
saries than  they  did  with  the  possible  competitors  whom 
they  met  in  their  medical  societies  at  home. 

He  undertook  to  collect  some  material  for  me  and 
soon  became  convinced  that  it  was  highly  desirable  that 
there  should  be  accessible  to  the  young  student  such  a 
fair  statement  of  the  requirements  for  success  as  would 
deter  the  thoughtless  and  the  poorly  endowed  from  un- 
dertaking the  preparation,  and  at  the  same  time  so 
alluring  as  to  stimulate  promising  candidates  to  exert 
themselves  to  make  the  fullest  preparation  before  enter- 


Introduction.  vii 

ing  upon  practice.  The  outcome  of  the  matter  was  that 
in  spite  of  the  exactions  of  a  very  busy  practice  to  which 
he  returned  he  undertook  the  preparation  of  this  book. 

After  the  manuscript  had  been  prepared  copies  were 
submitted  to  inquiring  young  men  and  they  were  in- 
vited to  personal  consultations  after  reading  it  so  that 
it  might  be  determined  what  additions  were  needed  to 
cover  all  possible  questions  which  might  arise  in  -their 
minds.    - 

Finally  copies  of  the  revised  manuscript  were  sub- 
mitted to  a  number  of  physicians  to  find  out  if,  in  their 
opinion,  the  conditions  as  they  existed  were  properly 
reflected.  In  submitting  the  manuscript  to  them  as- 
surances were  given  that  any  criticisms  which  they  had 
to  make  on  the  subject  were  not  to  be  given  out  over 
their  own  names,  as  it  was  believed  that  in  this  way  a 
freer  expression  of  opinion  could  be  secured. 

Some  of  these  critics  seemed  to  think  that  special 
references  should  be  made  to  courses  of  instruction 
which  they  themselves  had  found  to  be  particularly 
helpful;  others,  that  references  to  medical  sects  should 
have  been  omitted;  others  desired  that  mention  should 
be  made  of  the  fact  that  appointments  to  special  hos- 
pitals were  particularly  desirable  and  that  young  grad- 
uates should  be  cautioned  against  accepting  appoint- 
ments to  others.  Other  helpful  criticisms  were  care- 
fully considered  and  as  far  as  possible  were  incorporated 
in  the  text  in  making  the  final  revisions. 

Special  acknowledgments  are  due  to  Mr.  Robert  I. 
Raiman,  assistant  principal  of  the  Brooklyn  Boys'  High 
School,  who  read  all  of  the  final  proofs. 

E.  W.  Weaver. 


CONTENTS 

Chapter  Page 

I.  The  Histoky  of  Medicine 1 

II.  The  Place  of  the  Physician  in  So- 
ciety    V 

III.  Desirable  Native  Abilities 12 

IV.  The  Financial  Requikements 21 

V.  Financial  Eewards   28 

VI.  Pkospects 32 

VII.  Systems  of  Medicine 39 

VIII.  The   Medical   Colleges  and  their 

Requirements  for  Admission  .  -. . .  51 

IX.  A  General  Survey  of  the  Field  , . .  57 

X.  The  Army  Service 64 

XI.  The  Naval  Service 69 

XII.  The  Indian  Sekvece 77 

XIII.  Sanitary  Engineering   83 

XIV.  The  Philippine  Seevice 87 

XV.  The  Federal  Public  Health  Service  90 

XVI.  The  Public  Health  Service 96 

XVII.  Hospital  Service   105 

XVIII.  Laboratory  Work  112 

XIX.  Medical  Inspection  of  Schools 115 

XX.  Medical  Missions  118 

XXI.  Corporation  Service   125 

XXII.  The  Red  Cross 129 

XXIII.  Research  Work 132 

XXIV.  Commerce  and  Medicine 136 

XXV.  Specialism 140 

XXVI.  Women  in  Medicine 146 

XXVII.  The  Future  of  Medicine 151 

XXVIII.  Medical  Laws   157 

XXIX.  The  Code  of  Medical  Ethics 164 

Appendix  187 

ix 


CHAPTER  I. 

The  History  of  Medicine. 

According  to  the  beliefs  of  superstitious  ages,  cruel 
demons  were  watching  on  every  side  for  chances  to  do 
injury  to  man.  Gradually  tribes  of  men  built  up^  elab- 
orate ceremonies  and  invented  charms  to  drive  off 
demons,  and  they  arranged  sacrifices  and  scheduled 
feasts  in  order  to  enlist  the  aid  of  helpful  spirits.  The 
medicine  man  was  their  leader  in  the  performance  of 
these  ceremonies.  If,  from  the  traditions  of  the  tribe 
and  from  his  own  experiences,  he  learned  the  demands 
of  the  demons  well  enough,  and  understood  the  voices 
of  good  spirits  so  that  he  could  wisely  select  camping 
places,  know  the  seasons  for  making  victorious  attacks 
upon  enemies,  found  out  how  to  arrange  for  success  in 
the  annual  hunts,  discovered  what  herbs  to  place  in  the 
food  of  the  tribes  upon  the  solemn  occasion  appointed 
to  stay  plagues,  he  succeeded  in  extending  his  influence 
over  his  subjects. 

The  Mosaic  Law  gave  minute  directions  for  whole- 
some living.  These  directions  were  enforced  by  the 
priests.  The  disciples  of  ^sculapius  were  required 
to  record  the  stories  of  their  cures  upon  the  tablets 
which  were  placed  on  the  walls  of  the  shrines  erected  in 
honor  of  this  early  Greek  physician. 

Real  progress  in  medicine,  however,  begins  with  Hip- 
pocrates, a  Greek  philosopher,  who  was  bom  about  460 
B.C.     He  was  a  careful  observer  and  a  conscientious 

1 


2  Medicine  as  a  Profession". 

student  and  was  much  loved  and  highly  honored  by  his 
countrymen  He  knew  the  effects  of  many  drugs,  under- 
stood the  influences  of  unsanitary  surroundings  and  was 
able  to  ascribe  many  diseases  to  unwliolesome  diet.  In- 
asmuch as  the  early  Greeks  opposed  the  mutilation  of 
human  bodies,  he  knew  little  about  anatomy.  His  code 
of  ethics  has  given  dignity  to  the  medical  profession. 
Hippocrates  observed  carefully  the  progress  of  disease; 
Aristotle,  who  followed  him,  through  his  study  of  the 
structure  of  animals  made  our  first  known  contributions 
to  anatomy,  although  it  is  possible  that  the  Egyptian 
priests  who  were  accustomed  to  embalm  the  bodies  of 
the  dead  knew  something  of  the  structure  of  the  human 
body. 

Galen,  from  being  the  physical  director  to  the  gladi- 
ators of  an  Asiatic  town,  rose  to  the  important  position 
of  physician  to  the  great  emperor,  Marcus  Aurelius. 
He  knew  something  of  anatomy.  His  recorded  observa- 
tions show  that  he  knew  something  of  hygiene.  He 
recommended  gymnastic  exercises,  the  outdoor  life  and 
the  use  of  the  bath. 

The  physicians  of  the  later  Eoman  Empire  were 
imitators  who  based  their  practice  upon  the  writings  of 
Hippocrates  and  Galen.  For  want  of  careful  observa- 
tion and  continued  investigation,  medicine  declined  and 
this  decline  probably  led  to  the  first  legal  regulation  of 
the  practice  of  medicine.  Under  the  laws  of  the  empire, 
each  town  had  its  official  physician,  w'ho  examined  and 
licensed  practitioners.  After  the  time  of  Constantine, 
hospitals  and  dispensaries  were  established.  At  later 
periods  the  monasteries  became  hospitals. 

In  the  absence  of  any  strong  central  government 
during  the  several  hundred  years  of  confusion,  com- 


Dr.  William  Harvey 


The  History  of  Medicine.  3 

monly  spoken  of  as  the  dark  ages,  little  progress  was 
made  in  the  study  or  the  practice  of  medicine.  The 
Arabs  in  Spain  established  the  first  apothecary  shops 
and  through  their  studies  in  alchemy  accumulated  a 
varied  knowledge  of  remedies.  Avicenna,  one  of  their 
learned  men,  made  a  detailed  and  systematic  compilation 
of  the  writings  of  the  earlier  Greek  physicians  and  of 
their  Arabian  successors.  During  this  period,  the  works 
of  the  old  masters  were  taught  in  the  University  of  Sa- 
lerno. This  university  also  issued  diplomas  in  medicine 
to  women.  In  the  thirteenth  century,  we  find  that 
Frederick  II  of  Naples  decreed  that  no  one  should  be 
allowed  to  practice  the  healing  art  until  he  had  received 
his  diploma  and  had  served  one  year  with  an  experienced 
doctor.  The  final  examination  was  intended  to  test 
the  knowledge  of  the  applicant  about  the  writings  of 
Hippocrates,  who  had  lived  sixteen  hundred  years  be- 
fore, and  of  Galen,  who  had  been  dead  over  a  thousand 
years.  Each  candidate,  under  oath,  was  required  to 
promise  to  obey  the  laws  of  the  state,  live  a  pure  life, 
give  his  service  to  the  poor,  and  not  to  share  in  the 
profits  of  the  apothecary. 

Throughout  Europe  about  the  time  of  the  discovery 
of  America,  the  practice  of  medicine  was  almost  exclu- 
sively done  by  the  monks  and  the  clergy  of  the  lesser 
orders.  Their  religious  scruples  did  not  permit  them 
to  let  blood.  Surgery  gradually  fell  to  those  who  had 
diplomas.  These  learned  men  practiced  almost  exclu- 
sively among  the  wealthy,  and  in  addition  to  the  letting 
of  blood  for  bodily  distempers,  bandaging  their  wounds, 
they  shaved  their  heads.  The  surgeons  of  the  rich  were 
also  their  barbers  and  the  barbers  of  the  poor  were  their 
surgeons.     The  common  people,   also,  had  their  wise 


4  Medicine  as  a  Profession'. 

women  who  attended  them  in  sickness,  applied  home- 
made ointments  to  their  wounds,  and  supplied  them  with 
charms  to  ward  off  malign  influences. 

Strange  compounds  were  prescribed.  A  remedy  for 
consumption  as  set  forth  in  an  old  volume  was  prepared 
by  taking  thriftgrasse,  betony,  peygrasse,  fane,  fennel, 
Christmaswort,  and  making  them  into  a  potion  with 
clear  ale.  The  breath  of  a  donkey  was  supposed  to  drive 
out  poison.  A  bleeding  nose  was  to  be  cured  by  slipping 
a  key  down  the  patient's  back.  For  stopping  a  cough 
the  patient  was  advised  to  spit  into  the  mouth  of  a  frog. 
These  foolish  prescriptions  were  to  be  undertaken  in 
certain  phases  of  the  moon. 

When  we  consider  the  prevalence  of  such  absurd  no- 
tions and  learn  of  the  absence  of  sanitation  in  city  and  in 
country  and  read  of  the  filth  surrounding  military 
camps,  we  wonder  that  the  race  ever  survived.  In  truth, 
it  was  not  an  unusual  thing  for  plagues  to  devastate 
entire  countries.  In  the  reign  of  William  and  Mary, 
England  was  swept  by  an  epidemic  of  smallpox.  The 
queen  herself  fell  a  victim  to  the  scourge.  For  treat- 
ment, the  patient  was  given  a  black  powder  supposed  to 
have  been  made  from  the  ashes  of  burnt  toads.  During 
this  age  bleeding  was  practiced  for  every  kind  of  dis- 
order, either  by  opening  blood  vessels  or  by  applying 
blood-sucking  leeches.  It  is  said  of  one  great  French 
doctor,  that  in  his  hospital  he  used  100,000  leeches. 

During  these  centuries  of  stupidity,  valuable  experi- 
ences were  accumulated  and  the  foundations  were  laid 
for  discoveries  which  add  to  the  usefulness  of  the  physi- 
cians of  the  most  remote  hamlets  of  our  day.  These 
old-time  doctors  were  taught  to  follow  blindly  the  tradi- 
tions which  were  handed  down  to  them.     Their  knowl- 


The  History  of  Medicine.  5 

edge  of  the  human  body  was  too  limited  to  permit  thean 
to  reason  intelligently  about  the  causes  of  disease  and 
the  nature  and  effect  of  their  remedies ;  they  had  no  in- 
struments ;  they  were  ignorant  of  the  common  principles 
of  everyday  science  as  we  know  them  and  they  had  never 
learned  the  methods  of  investigating  new  problems. 

As  a  new  age  dawned  a  period  of  rapid  progress  fol- 
lowed in  medicine,  as  in  other  departments  of  knowl- 
edge, introducing  us  to  a  long  procession  of  men  of  great 
brilliance.  Andreas  Vesalius  published  an  elaborate 
book  on  anatomy  which  stimulated  the  teaching  of  that 
subject  in  all  the  universities;  Montanus  of  Padua  lec- 
tured to  his  students  at  the  bedsides  of  his  patients,  in 
which  practice  he  was  followed  by  Sylvius  of  Holland 
and  the  great  Boerhaave  of  Leyden.  They  taught  men 
how  to  study  the  progress  of  disease,  how  to  learn  the 
effects  of  disorders  by  examining  the  bodies  of  the  dead, 
and  how  to  apply  new  discoveries  in  physics  and  chem- 
istry in  the  art  of  healing.  William  Harvey,  an  English 
physician,  in  1628,  published  to  the  world  his  doctrine 
of  the  circulation  of  the  blood.  With  the  invention  of 
the  microscope  the  nature  of  the  tissues  of  the  body  was 
better  understood,  and  after  the  invention  of  the  stetho- 
scope by  Laennec,  a  French  physician,  the  diagnosis  of 
diseases  of  the  chest  was  established  upon  sound  prin- 
ciples. 

The  invention  of  printing  aided  in  the  circulation  of 
these  new  discoveries  and  in  the  wider  distribution  of 
the  writings  of  the  older  investigators  and  practitioners. 
Medical  schools  multiplied.  Better  equipped  men  began 
to  interpret  anew  the  experiences  of  their  predecessors 
and  to  carry  on  the  search  for  new  remedies.  The  uses 
of  Peruvian  bark  were  learned  from  the  natives  of  South 


6  Medicine  as  a  Profession". 

America,  about  1649,  introducing  a  surer  metliod  for 
handling  fevers.  In  1798,  Jenner  announced  to  the 
world  a  method  for  controlling  smallpox  by  vaccination. 
This  list  of  beacon  lights  in  medicine  might  be  continued 
at  great  length  but  the  details  of  the  story  of  progress 
belong  to  the  history  of  medicine  and  the  biographies  of 
its  illustrious  men. 

With  the  recognition  promptly  given  to  those  who 
have  made  new  discoveries,  there  has  come  about  that 
change  in  attitude  which  has  made  of  every  physician  of 
our  day  a  scientific  investigator  and  has  filled  our  clinics 
and  laboratories  with  young  men  eager  to  add  some  new 
contributions  to  this  important  science  and  it  has 
crowded  our  hospitals  with  practitioners  whose  chiefest 
desire  is  the  perfection  of  some  details  of  their  art. 
The  doctor  of  to-day  is  the  very  prince  of  professional 
men.  The  service  which  he  renders  may  not  be  of  a 
higher  order  than  the  services  which  are  rendered  by 
men  in  other  professions  but  his  spirit  is  one  of  greater 
and  more  devoted  unselfishness. 

Well  were  it  for  the  candidate  if,  before  making  his 
final  choice,  he  could  take  time  to  read  the  life  histories 
of  some  great  physicians.  If  he  would  succeed,  he  must 
remember  that  he  is  to  enter  the  ranks  of  men,  many  of 
whom  have  mastered  much  of  the  accumulated  inher- 
itance of  this  age  by  long  and  patient  study,  and  that 
when  he  enters  upon  the  practice  of  his  profession  he 
must  go  before  a  public  which  for  generations  has  been 
accustomed  to  be  ministered  to  ungrudgingly  by  those 
who  were  moved  chiefly  by  motives  other  than  the  tan- 
gible rewards  of  their  profession. 


Edward  Jenner^  M.D. 


CHAPTER  II. 

The  Place  of  the  Physician  in  Society. 

Some  persons  will  seek  to  enter  a  calling  so  as  to 
establish  themselves  in  such  a  way  tliat  they  may  later 
engage  in  the  larger  and  fuller  relations  of  life,  others 
take  up  a  vocation  in  the  expectation  of  making  it  their 
exclusive  pursuit.  Lawyers  frequently  change  from 
their  profession  to  take  up  mercantile  pursuits,  become 
leaders  in  corporations  or  to  engage  in  public  service. 
Men  who  have  been  trained  for  the  ministry,  too,  are 
found  in  other  walks  of  life.  Ordinarily  in  every  group 
of  professional  men  about  one  third  of  all  are  over  forty- 
five  years  of  age.  Of  all  the  physicians  enumerated  by 
the  census  of  1910,  nearly  forty  per  cent,  were  over  this 
age.  This  proba;bly  means  that  those  who  prepare  for 
this  profession  continue  in  it  and  that  it  is  more  than 
likely  that  they  do  so  because  they  find  in  their  work 
the  durable  satisfactions  of  life. 

These  durable  satisfactions  for  the  average  man  in- 
clude more  than  the  financial  rewards  which  come  to 
him  from  his  work  and  it  may  be  well  to  consider  what 
medical  men  have  achieved  outside  of  their  daily  occupa- 
tions. They  have  been  the  pioneers  in  many  scientific 
fields.  Ever  searching  for  new  remedies,  they  have 
studied  plants  and  become  our  first  botanists.  Otto 
Brunfels,  a  physician  of  Berne,  may  be  called  the  father 
of  the  botanical  sciences.  Dr.  Benjamin  Barton  of 
Philadelphia  and  Jacob  Bigelow,  a  Boston  practitioner, 
2  7 


8  Medicine  as  a  Profession. 

achieved  world-wide  reputations  as  botanists  before 
Americans  attracted  attention  in  literary  fields.  Theo- 
dore Schwann,  the  son  of  a  German  cobbler,  became  the 
founder  of  biology.  John  and  William  Hunter,  who 
were  in  their  days  the  leading  physicians  of  England, 
were  also  the  leading  naturalists.  Dr.  Joseph  Leidy  of 
Philadelphia  was  a  pioneer  in  zoology.  Galvani,  who 
was  the  first  to  call  attention  to'  animal  electricity,  was 
an  Italian  physician.  Lothar  Meyer  of  Germany  and 
Dr.  Berzelius  of  Sweden  made  important  advances  in 
chemistry,  to  which  science  physicians  of  all  ages  have 
made  contributions. 

From  the  very  nature  of  their  training  we  would  ex- 
pect doctors  to  be  students  and  lovers  of  books  and  it  is 
not  surprising  to  find  in  their  ranks  the  makers  of  books 
of  popular  interest  as  well  as  writers  of  books  dealing 
with  professional  and  scientific  subjects.  Sir  Thomas  ^ 
Browne's  Religio  Medici  has  had  appreciative  readers 
for  nearly  three  centuries.  Dr.  William  Osier,  of  our 
day,  writes  that  it  was  the  reading  of  this  book  that  de- 
termined him  to  become  a  physician.  John  Keats  wrote 
verses  while  serving  as  an  attendant  at  a  London  hos- 
pital. Dr.  Oliver  Wendell  Holmes  is  more  widely  known 
for  his  contributions  to  literature  than  for  his  lectures 
to  Harvard  medical  students.  Thousands  who  have  been 
entertained  by  the  delightful  stories  of  S.  Weir  Mitchell 
never  knew  that  he  was  one  of  the  leading  physicians  of 
his  day,  and  every  school  boy  has  found  healthful  enter- 
tainment in  the  reading  of  Rab  and  his  Friends  by  Dr. 
John  Brown. 

The  advances  in  sanitation  to  which  we  owe  the  im- 
proved living  conditions  of  our  cities  and  the  redemption 
of  hitherto  uninhabitable  portions  of  the  globe  have  been 


Place  of  the  Physician  in  Society.  9 

made  under  the  leadership  of  puhlic-spirited  medical 
men.  The  ventilation  of  factory  buildings,  the  use  of 
safety  devices  on  dangerous  machinery  and  the  pro- 
tection of  workingmen  in  hazardous  occupations  has  been 
brought  about  through  the  efforts  of  medical  societies. 

In  self-f orgetfulness,  these  men  have  performed  heroic 
service  on  the  field  of  battle  and  too  often  history  has 
permitted  the  dashing  performances  of  military  leaders 
to  obscure  the  vs^ork  which  was  done  by  the  medical 
staffs  of  the  armies  in  earing  for  the  campaigners  and 
the  tireless  labors  of  the  surgeons  in  the  wake  of  retreat- 
ing armies.  Volumes  have  been  written  about  the  com- 
manding officers  of  the  armies  in  the  wars  between 
Francis  I.  and  Charles  Y.,  while  mention  is  hardly  made 
of  the  improved  methods  of  treating  wounds  by  Ambroise 
Pare,  the  chief  surgeon  of  the  French  armies.  If  his- 
tory were  properly  written,  Alphonse  Laveran,  who  dis- 
covered the  cause  of  malaria  while  with  the  French 
armies  in  Algeria,  would  be  accorded  as  much  prom- 
inence as  that  which  is  given  to  the  military  leaders  of 
that  expedition,  and  the  labors  of  Walter  Eeed  and  his 
associates  in  dealing  with  typhus  and  yellow  fever  dur- 
ing the  Spanish  American  War  would  far  outshine 
the  heroism  of  the  leader  in  the  charge  on  San  Juan 
Hill. 

Nor  should  it  be  wondered  at  that  those  whose  work 
has  to  do  with  the  mysteries  of  life  and  death  should  have 
in  their  ranks  persons  of  great  piety  and  deep  religious 
convictions.  Medicine  has  no  nobler  pages  than  those 
which  record  the  stories  of  the  lives  of  Dr.  Grenfell,  the 
medical  missionary  to  the  scattered  people  along  the 
coast  of  Labrador,  and  Dr.  David  Livingstone,  who  first 
penetrated  into  the  interior  of  darkest  Africa. 


10  Medicine  as  a  Profession. 

Physicians  have  been  influential  in  many  ways,  be- 
cause of  their  intimate  personal  relations,  through  which 
they  have  won  the  confidences  of  large  numbers  of  their 
fellows.  As  members  of  boards  of  trustees  of  colleges 
and  universities  and  of  educational  committees  they 
have  been  leaders  in  popular  education.  They  have 
done  more  than  any  other  class  in  establishing  hospitals, 
in  promoting  prison  reform  and  in  improving  the  meth- 
ods for  caring  for  the  dependent  and  defective  classes. 

The  members  of  the  profession  have  done  their  share 
in  the  fields  of  politics  and  government.  Vesalius  was 
the  confidential  adviser  of  the  great  emperor,  Charles  V, 
not  only  in  matters  relating  to  the  health  of  the  royal 
household  but  in  the  affairs  of  state;  Thomas  Linacre 
was  not  only  a  physician  but  a  leading  statesman  of  the 
time  of  Henry  VIII ;  Corvisart,  the  physician  to  Napo- 
leon, influenced  him  in  many  affairs;  Benjamin  Push 
was  one  of  the  signers  of  the  Declaration  of  Independ- 
ence and  was  regarded  as  one  of  the  foremost  citizens 
of  Philadelphia  and  highly  honored  because  of  the  serv- 
ices which  he  rendered  during  a  scourge  of  yellow  fever ; 
Josiah  Bartlett,  Lyman  Hall,  and  Oliver  Olcott  were 
also  signers  of  the  Declaration  and  later  served  as  gov- 
ernors of  their  respective  states ;  and  Matthew  Thornton, 
another  signer,  rendered  important  services  to  the  Con- 
tinental armies  during  the  Revolution  and  later  was  a 
member  of  congress. 

During  recent  years  the  period  of  preparatory  study 
has  been  lengthened  and  professional  progress  has  been 
so  rapid  that  only  by  the  most  careful  management  of 
his  time  and  energy  has  the  medical  student  and  the 
practitioner  been  able  to  keep  pace  with  progress  and 


Place  op  the  Physician  in  Society.  11 

more  and  more  meclicine  lias  tended  to  become  the  ex- 
clusive pursuit  of  the  members  of  the  profession. 

This  tendency  towards  exclusiveness  of  interest  seems 
to  make  it  all  the  more  desirable  for  the  physician  to  have 
some  avocation  to  which  he  can  turn  for  a  change  or 
some  hobby  to  carry  his  mind  away  from  the  burden  of 
his  daily  routine.  Many  of  the  older  physicians  have 
turned  to  some  secondary  pursuits,  in  which  not  a  few 
have  distinguished  themselves.  Leopold  Auenbrugger, 
the  great  Viennese  of  the  eighteenth  century,  was  author 
of  a  musical  comedy ;  Claude  Bernard,  the  noted  French 
physiologist,  was  writer  of  plays;  Titus  Tobler,  a  Swiss 
physician  of  the  nineteenth,  century,  achieved  fame 
as  an  orientalist.  The  practitioners  of  later  years  have 
found  relief  from  the  burdens  of  their  work  in  athletics 
and  sports,  in  collecting,  and  in  country  life  occupations.  ; 

After  this  brief  review,  as  an  introduction  to  the  next  i 
chapter,  we  may  say  that  he  who  would  succeed  in  this  t 
time-honored  profession  must  have  in  him  a  promise  of 
physical  endurance  and  such  a  power  of  close  intellectual  ' 
application  as  will  help  him  to  the  ready  mastery  of  \ 
great  accumulations  of  knowledge.     He  must  be  well 
trained  to  the  wise  use  of  his  time  and  his  energy  and  be 
prepared  to  deny  himself  all  other  ambitions  and  yet 
have  some  other  interests  sufficiently  absorbing  to  take   / 
his  mind  from  his  day's  work. 

Reading  References. 

The  interested  student  will  do  well  to  read  the  sketches 
of  the  men  mentioned  in  these  two  chapters  as  they  are 
given  in  any  good  encyclopaedia  or  in  biographical  dic- 
tionaries and  also  a  few  of  the  more  extended  biographies 
which  are  listed  in  the  appendix  to  this  book. 


\ 


CHAPTER  III. 

Desirable  Native  Abilities. 

In  answer  to  the  question — Shall  my  son  prepare  for 
medicine? — a  distinguished  physician  wrote  to  his 
friend :  *^  There  is  on  earth  nothing  greater  or  more  beau- 
tiful than  man,  and  the  study  of  mankind  is  the  most 
difficult  and  exalted  subject  of  thought  and  action.  Hu- 
man development  and  ambition,  human  life  and  ills  are 
all  in  the  highest  degree  remarkable  and  touching.  But 
you  must  bring  with  you  keen  eyes  and  acute  ears ;  a  great 
gift  for  observation ;  patience,  and  yet  more  patience  for 
endless  study;  a  clear  critical  mind;  an  iron  will 
strengthened  by  opposition,  but  yet  a  warm  and  tender 
heart,  comprehending  and  feeling  every  sorrow;  a  rev- 
erent spirit  and  austerity  that  is  superior  to  sensuality, 
money  or  eminence;  furthermore  a  decent  appearance, 
polished  demeanor,  adroit  fingers  and  health  of  body  and 
soul.  All  of  these  you  must  possess  if  you  would  not 
become  either  an  incompetent  or  an  unhappy  physician. 
You  must  stagger  under  the  crushing  burden  of  unend- 
ing knowledge,  and  yet  preserve  the  light-heartedne'ss 
of  the  poet ;  you  must  know  all  the  arts  of  the  charlatan 
and  yet  remain  an  honest  man;  once  for  all,  medicine 
must  be  your  creed  and  your  politics,  your  happiness 
and  your  misery.  Therefore,  advise  no  one  to  become  a 
physician.  If  he  still  wishes  to  do  so,  warn  him  against 
it  often  and  earnestly;  but  if  he  persists  in  spite  of  all, 

12 


Desirable  Native  Abilities.  13 

give  him  your  blessing,  if  he  is  worth  it,  for  he  will  need 
it." 

This  advice  is  equivalent  to  saying  that  no  young 
man  should  think  of  entering  this  profession,  and  no 
other  profession  for  that  matter,  unless  he  has  a  sure 
faith  in  his  abilities  to  overcome  all  obstacles  which  he 
may  find  in  his  way.  Surely  there  is  no  surer  way  by 
which  a  young  man  may  fortify  himself  than  by  placing 
in  order  all  objections  which  can  be  raised  against  a  cer- 
tain course  of  action,  and  by  successively  proving  that 
none  of  them  is  unsurmountable.  Unfortunately  young 
men  should  enter  upon  their  definite  preparation  for 
medicine  about  the  age  of  twenty  or  before,  at  which 
time,  the  spirit  of  youth  with  its  vacillations  has  not 
always  been  outgrown.  It  is  not  ever  best  for  friends 
to  be  too  real  in  the  terrorism  which  they  picture  to  the 
anibitious  youth  who  comes  to  them  for  advice.  It  may 
be  safe  to  say  that  the  chances  of  success  in  a  profession 
increase  with  the  strength  of  the  call  which  compels 
the  candidate  to  enter  upon  that  profession  and  it  may 
also  be  said  that  for  those  who  find  their  highest  satis- 
faction in  social  service,  medicine  supplies  a  well-defined 
field  of  work. 

^  Here  is  an  extract  from  a  letter  written  by  a  medical 
student  in  Paris  in  1832:  "The  morning  from  seven  to 
ten  is  occupied  by  a  clinic  at  the  hospital ;  there  are  sev- 
eral clinics;  each  of  them  has  its  advantages.  I  shall 
vary  my  attendance  at  the  different  hospitals,  but  at 
this  moment  we  are  following  Piorry  at  the  Salpetriere, 
two  or  three  miles  from  our  lodgings.  From  Salpetriere 
we  hurry  to  La  Pitie;  we  listen  to  a  surgical  lecture, 
reach  home  in  time  for  breakfast  and  then  to  the  school 
of  medicine.     Lectures,  with  a  private  course  in  anat- 


14  Medicine  as  a  Profession. 

omy,  fill  up  the  day  till  four ;  after  wliicli  a  private  clinic 
introduces  me  to  some  very  interesting  cases.  We  dine 
at  five  and  then  again  to  lectures  till  eight. 

This  letter  makes  no  mention  of  tl^o  time  needed  to 
write  up  notes  and  to  digest  lectures  and  to  do  reading. 
Such  a  routine  requires  the  strong  physical  constitution 
of  a  well-matured  individual.  It  calls  for  a  very  tena- 
cious purpose  to  carry  a  student  successfully  through 
from  four  to  eight  of  the  best  years  of  his  life  of  the 
unrenumerative  labor  of  his  undergraduate  days  and  it 
likewise  requires  equally  stern  qualities  to  resist  the 
physically  deteriorating  and  discouraging  influences 
which  come  in  the  following  years  of  watchful  waiting 
for  patients.  Moreover  since  the  physician  receives  his 
largest  monetary  returns  from  his  practice  after  the 
ripened  judgment  of  that  period  of  life  when  most  other 
men  are  ready  to  retire  we  must  conclude  that  a  robust 
constitution  is  a  first  essential  from  a  candidate  who 
expects  to  secure  reasonably  profitable  returns  from  his 
investments  of  time  and  money  in  preparing  for  this 
profession. 

The  growing  conviction  that  the  profession  makes 
high  requirements,  perhaps,  accounts  for  a  constantly 
increasing  number  of  the  matriculates  of  our  medical 
schools  who  drop  out  before  graduation.  This  also  ex- 
plains why  in  the  ten  years  preceding  1914  the  number 
of  male  students  in  these  schools  has  decreased  40  per 
cent.;  the  number  of  male  graduates,  37 J  per  cent.;  the 
number  of  female  students  decreased  44  per  cent.;  the 
number  of  female  graduates,  50  per  cent. 

The  medical  student  must  detach  himself  from  his 
own  circle  in  order  to  give  his  time  to  his  studies  and 
yet  when  he  would  begin  his  practice  he  accumulates  his 


Desirable  Native  Abilities.  15 

patients  by  his_ability  to  enter  into  the  social  life  of  his 
commnnity;  he  must  be  trained  in  scientific  and  exact 
methods  and  yet  be  able  to  meet  the  frivolous  somewhat 
on  their  own  plane;  he  must  be  social  and  affable,  and 
yet  he  is  forbidden  to  bring  into  his  social  relations  any 
echoes  of  his  daily  work;  trained  in  the  making  a  true 
estimate  of  men  and  women  and  yet  blind  to  the  frail- 
ties of  humanity;  professionally,  firm  in  dealing  with 
the  truth  as  he  sees  it  and  socially  ready  to  be  all  things 
to  all  men.  All  of  which  means  that  he  should  have  had 
behind  him  a  broad  social  experience,  the  lack  of  which 
is  perhaps  one  of  the  heaviest  handicaps  to  the  young 
men  from  the  working  classes  and  the  boy  from  the 
country  with  limited  social  opportunities.  Eesidence 
during  his  medical  course  in  a  social  settlement  or  in  a 
Young  Men^s  Christian  Association  home  may  be  recom- 
mended as  a  means  for  supplying  an  extended  social 
experience. 

A  large  number  of  those  who  make  up  the  army  of 
150,000  American  medical  men  and  most  of  the  3,500 
recruits  who  leave  the  medical  colleges  every  year  to 
take  the  places  of  those  who  drop  out  of  this  army  have 
great  natural  gifts  ,and  are  filled  with  the  true  scientific 
spirit  for  investigation  and  for  giving  to  the  world  the 
results  of  their  studies  which  means  a  great  annual  flood 
of  medical  literature.  Ignorance  of  tried  and  proven 
methods  of  saving  from  death  in  any  of  its  varied  forms 
is  criminal;  so  that  we  must  add  that  it  requires  great 
intellectual  aptitudes  to  enable  a  practitioner  to  keep 
squared  with  himself,  to  say  nothing  of  his  reckoning 
with  the  public  and  his  competitors.  This  means  that 
the  young  man  who  would  succeed  in  this  profession 
should  be  able  to  accomplish  the  prescribed  school  course 


16  Medicine  as  a  Profession". 

in  much  better  than  the  average  pace;  say  finish  the 
high-school  course  at  sixteen  and  the  college  course  by 
the  time  the  age  of  twenty  is  reached.  He  should  be 
ready  and  excellent  in  his  freehand  drawing,  which 
means  a  gift  for  observation;  dexterous  in  his  manual 
training,  which  means  a  facility  to  adapt  means  to 
ends;  commendable  in  his  mathematics,  which  means 
skill  in  reasoning;  excellent  in  languages,  which  signi- 
fies readiness  in  extracting  information  from  his  profes- 
sional books  later  in  his  career ;  absorbed  in  his  sciences, 
which  gives  promise  of  the  ability  to  acquire  the  essen- 
tial spirit  of  his  profession. 

The  period  of  physical  growth  ends  with  many  at 
twenty  and  the  period  of  intellectual  growth  is  with  some 
more  limited,  and  such  may  do  well  in  the  routine  work 
of  the  shop.  The  business  man  can  crowd  a  great  deal 
of  work  into  his  day,  much  of  which  is  of  a  routine  char- 
acter; but  that  community  whose  physician  has  fallen 
into  the  routine  of  beginning  every  consultation  with  a 
diagnosis  and  ending  with  a  physic  will  be  called  upon 
to  lay  increased  burdens  upon  those  whose  duty  it  is  to 
pray  for  its  living  and  its  dead. 

Let  us  look  into  the  daily  life  of  a  physician* to  see 
just  what  it  calls  for  in  the  way  of  powers  of  endurance. 
Just  as  he  is  entering  upon  a  good  night's  rest  his  tele- 
phone bell  calls  him  to  a  remote  neighborhood,  where  in 
the  midst  of  the  surroundings  of  the  poor,  frantic  par- 
ents are  watching  a  suffering  child.  The  pulse  is  feeble. 
The  situation  calls  for  a  man  with  an  observant  eye 
which  has  been  trained  by  long  and  patient  scientific 
study,  to  the  quick  and  confident  decision  which  char- 
acterizes the  man  accustomed  to  all  the  thinking  proc- 
esses, and  the  resourcefulness  which  comes  from  a  wide 


Desirable  "N"ative  Abilities.  17 

experience,  in  order  that  an  operation  may  be  performed 
under  nnfavoraible  conditions  without  trained  help,  and 
courage  to  face  the  possibility  of  carrying  the  malignant 
diphtheria  back  to  his  own  children.  A  brief  rest  and 
then  his  morning  office  hours  with  their  procession  of 
suffering  humanity;  the  nervous  woman  who  needs 
mental  treatment  more  than  medicine;  the  woman  of 
careless  habits  and  evil  ways  who  should  be  treated  to 
the  rigors  of  the  law,  whose  case  he  can  handle  because 
he  has  had  the  shrewdness  of  the  detective  to  discover 
the  causes  of  ailments  which  she  would  conceal  from 
him ;  and  then  the  man  who  would  have  the  doctor  falsely 
certify  to  physical  disabilities,  so  as  to  permit  him  to 
escape,  for  a  time,  deserved  punishment  by  being  ex- 
cused from  obeying  the  edict  of  a  court  of  law.  He  is 
prominent  and  influential,  he  beseeches  and  threatens. 
The  case  calls  for  a  high  degree  of  moral  rectitude 
which  disregards  consequences. 

In  his  afternoon  round  of  visits,  he  finds  at  the  bedside 
of  a  sufferer  from  a  long-standing  disease,  a  friend  who 
represents  to  his  patient  that  another  physician  has 
treated  such  cases  much  more  successfully  by  entirely  dif- 
ferent methods ;  the  consultation  must  be  carried  on  with 
a  forgiving  spirit  into  which  few  other  men  could  readily 
enter.  The  afternoon  ends  with  a  visit  to  a  hospital  for 
contagious  diseases,  in  which  one  of  his  own  patients 
has  taken  an  unfavorable  turn.  At  the  end  of  the  long 
day  he  must  be  able  to  concentrate  his  mind  upon  the 
long  history  of  a  stubborn  case.  He  reviews  his  former 
judgments  of  the  disturbing  causes,  recalls  to  his  mind 
long  lists  of  similar  cases,  examines  into  the  diet  of  the 
patients,  analyzes  the  reports  of  the  nurses,  and  notes 
the  effects  of  the  prescribed  treatment  in  order  to  deter- 


18  Medicine  as  a  Profession. 

mine  what  modifications  in  his  methods  of  handling  the 
case  are  desirable. 

The  day  may  not  be  without  a  call  from  a  fellow  prac- 
titioner for  a  consultation  over  a  troublesome  case,  in 
the  handling  of  which  he  is  sure  that  his  fellow  has 
blundered,  yet  concerning  which  he  dare  not  fully  ex- 
press himself  without  having  his  motives  misconstrued 
and  this  calls  for  Christian  forbearance.  Then  comes 
a  brief  rest  and  the  evening  office  hours. 

Less  than  in  any  other  line  of  work  requiring  a  long 
period  of  intellectual  training  will  either  race  or  color 
be  a  handicap  to  a  physician.  In  those  quarters  of  our 
cities  inhabited  by  the  descendants  of  the  foreign  born 
there  is  the  same  opportunity  for  those  of  any  given 
class  to  win  rewards  which  are  relatively  equal  to  those 
which  are  open  to  the  native  born  among  their  own 
people.  That  only  10.8  per  cent,  of  our  physicians  in 
this  country  are  foreign  born  when  20.5  per  cent,  of  the 
population  are  foreign  born,  and  that  only  2  per  cent, 
of  the  physicians  are  colored  when  13.6  per  cent,  of  the 
population  is  colored  is  perhaps  due  to  the  fact  that  not 
so  many  of  these  classes  can  afford  the  outlay  which  is 
needed  by  those  who  would  prepare  for  the  practice  of 
medicine. 

In  1907  there  were  28  registered  negro  physicians  in 
Philadelphia  and  14  in  Pittsburgh  and  in  1912  there 
were  59  in  the  former  and  28  in  the  latter  city.  A  negro 
graduate  of  the  Harvard  Medical  School  who  began  his 
practice  in  Philadelphia  in  1869  continued  up  to  his 
death  in  1912,  and  the  first  negro  woman  graduate  who 
began  to  practice  in  1878  is  still  in  practice  in  that  city. 

Though  he  has  a  strong  constitution  to  hold  himself 
in  readiness  for  emergencies  in  each  of  the  twenty-four 


Desirable  Native  Abilities.  19 

hours  of  the  day  when  others  are  clamoring  to  have  the 
working  day  restricted  to  eight  hours  for  six  days  of  the 
week,  and  though  he  has  physical  courage  to  enter  pest 
houses  and  lazarettos  and  the  moral  courage  to  refuse 
to  countenance  wrong,  the  intellectual  grasp  to  possess 
all  knowledge  and  an  evergrowing  mind,  diplomacy  and 
tact  and  Christian  forbearance  and  social  training  which 
will  make  him  welcome  in  all  circles,  the  physician  will 
not  be  happy  in  his  work  unless  he  will  be  proof  against 
envy  as  he  sees  inferior  men  in  business  overburdened 
with  the  possession  of  those  things  which  appeal  to  the 
taste  of  cultured  people  and  which  are  denied  to  him 
and  his,  and  without  jealousy  when  he  sees  unworthy 
men  win  honors  and  enjoy  the  emoluments  of  high 
places  while  he  must  perforce  live  his  solitary  life  with 
an  unending  succession  of  human  frailties  and  in- 
firmities. 

It  may  be  repeated  that  many  of  these  essential  qual- 
ities are  developed  by  men  and  women  sometime  after 
the  age  when  preparation  for  this  profession  should  be 
planned.  For  those  who  fail  to  develop  some  of  these 
essentials  for  success  after  making  their  preparation 
there  is  open  that  very  large  field  of  the  business  of  pro- 
viding the  supplies  which  are  needed  in  medical  work 
and  in  which  the  training  given  by  the  medical  school 
will  stand  in  good  stead ;  then  there  is  that  ever-growing 
field  of  medical  research  in  which  those  who  are  not 
adapted  for  general  practice  may  hope  to  succeed;  and 
that  almost  untouched  field  of  industrial  betterment,  for 
success  in  which  there  could  be  no  better  preparation 
than  a  medical  course.  Those  who  later  develop  a  high 
degree  of  executive  ability  will  find  an  attractive  field 


20  Medicine  as  a  Profession". 

in  public  health  movements  and  in  the  management  of 
hospitals  and  asylums  and  in  public  charities. 

In  spite  of  the  high  requirements  it  seems  that  the 
percentage  of  failures  in  the  profession  is  not  high. 
Sir  James  Paget  of  London  followed  the  history  of  a 
thousand  medical  students  in  Great  Britain  and  Ireland. 
He  concludes  that  23  of  these  may  be  considered  to  have 
achieved  distinguished  success;  66,  considerable  success; 
507,  fair  success;  24,  limited  success;  41  died  before 
beginning  to  practice  and  87  within  twelve  years  after 
beginning  their  careers;  56  failed  entirely  and  96  aban- 
doned the  profession  for  other  callings.  A  careful  study 
of  biographical  dictionaries  discovered  a  very  few  per- 
sons who  were  educated  for  medicine  who  took  up  other 
callings.  A  few  were  found  who  had  entered  journalism, 
one  who  took  up  play  writing;  several  who  became  offi- 
cers in  business  corporations  and  a  few  who  took  up 
social  work  and  several  who  entered  the  ministry.  With 
the  stricter  requirements  for  admission  to  the  medical 
colleges  the  percentage  of  failures  will  likely  be  lessened. 


CHAPTEE  IV. 

The  Financial  Eequirements. 

The  prudent  man  who  would  embark  upon  a  long 
voyage  first  takes  an  account  of  his  resources  and  tries  to 
estimate  the  cost  of  the  trip.  Young  people  for  whom 
liberal  provisions  have  been  made  by  self-sacrificing 
parents  and  the  tax-paying  public  during  the  period  of 
their  infancy,  sometimes  expect  such  subsidies  to  con- 
tinue long  after  they  have  passed  from  infancy  to  man- 
hood. It  is  true  that  our  states  and  the  citizens  have 
given  liberally  towards  the  encouragement  of  professional 
education,  but  some  expenses  must  be  met  by  the  stu- 
dent and  he  should  at  the  outset  have  a  fairly  definite 
idea  of  such  expenses  and  his  prospects  of  meeting  them 
as  they  become  due. 

Dr.  Samuel  Bard,  who  left  the  colonies  before  the 
Eevolution  in  order  to  get  his  medical  education  at  the 
University  of  Edinburgh,  estimated  upon  his  return  that 
his  outlay  for  travelling,  living  and  schooling  was  nearly 
a  thousand  pounds.  Although  the  purchasing  value  of 
money  has  changed  since  then,  yet  from  four  to  five 
thousand  dollars  comes  very  near  to  being  the  cost  of  a 
medical  education  in  this  day. 

Thirty-four  medical  colleges  require  two  or  more  years 
of  college  work  before  admission  and  fifty  require  one 
full  year,  so  our  estimate  may  well  be  based  upon  six 
years  of  study  after  the  completion  of  a  high-school 
course  or  its  equivalent. 

21 


22  Medicine  as  a  Peofession". 

We  will  consider  a  boy  from  a  town  remote  from  a 
medical  college  who  would  enter  upon  the  study  of  medi- 
cine and  his  brother  who  will  go  into  skilled  trade. 
The  mechanic  is  not  generally  accepted  in  a  trade  as  an 
apprentice  until  he  is  sixteen  and  in  some  trades  not 
until  he  is  eighteen  years  old.  By  this  time  the  medical 
student  should  be  ready  for  college  and  by  the  time  the 
mechanic  has  served  his  apprenticeship  and  be  ready  to 
earn  wages  averaging  from  $750  to  $1,000  a  year,  the 
medical  student  will  be  within  one  year  of  graduation. 
During  his  apprenticeship  the  mechanic  will  possibly 
earn  enough  to  pay  for  his  own  support ;  so  for  the  pur- 
poses of  comparison  we  must  add  to  the  expenses  of  a 
medical  education  the  cost  of  living  and  we  will  assume 
that  inasmuch  as  the  average  length  of  the  term  in 
the  medical  college  is  thirty-four  weeks,  that  the  medical 
student  during  his  vacations  will  be  able  to  earn  enough 
to  pay  for  his  clothes  and  spending  money. 

In  one  fourth  of  the  medical  colleges  of  the  country, 
the  total  fees  are  between  $600  and  $700.  In  another 
one  third  the  charges  are  in  excess  of  this  amount,  so 
that  we  will  assume  $750  as  the  total  of  fees  for  tuition. 
For  laboratory  expenses,  text-books,  reference  books  and 
society  dues  we  must  allow  $250.  Boarding  even  in 
mess  halls  and  boarding  clubs  will  likely  be  more  rather 
than  less  than  $800  for  the  four  years.  This  brings 
the  cost  exclusive  of  travelling  expenses  to  $1,800.  In 
New  York,  Boston  and  Chicago,  it  is  more  likely  that 
the  cost  will  be  $2,500  for  male  students  and  $3,000 
for  those  female  students  who  are  not  able  to  live  in 
their  own  homes  or  with  relatives.  To  this  must  be 
added  the  cost  of  the  time  at  college  before  entering 
upon  his  medical  studies.     Young  men  can  usually  ex- 


The  Financial  Requirements.  23 

pect  to  secure  free  tuition  or  college  scholarships  in  most 
of  the  states,  so  that  the  expenses  at  college  will  be  from 
$500  to  $1,000  for  the  two  years.  This  will  make  a  total 
expense  of  from  $2,250  to  $4,000  without  making  any 
allowance  for  sickness  or  failures  in  promotion. 
One  physician  estimated  his  expenses  as  follows: 

Tuition $150 

Laboratory  expenses 10 

Board  and  lodging 160 

Text-books 60 

Clothing  and  incidentals 130 

Traveling  expenses 40 

Total $550 

For  the  four  years $2,200 

This  total  does  not  include  any  allowance  for  the  pre- 
liminary college  expenses  nor  for  loss  in  earnings  while 
attending  medical  college,  and  it  is  based  upon  living 
expenses  in  a  city  in  which  expenses  are  comparatively 
low. 

An  out-of-town  student  who  was  graduated  from  one 
of  the  best  New  York  medical  colleges  in  1914  reported 
that  his  entire  expenses  were  as  follows : 

For  the  preparatory  year $800.00 

His  first  year 755.28 

His  second  year 819.83 

For  the  third  year 1,133.46 

For  the  fourth  year  1,300.00 

A  more  economical  student  at  the  same  school  re- 
ported a  total  expense  for  the  four  years  at  medical  col- 
lege of  $1,370  exclusive  of  living  expenses.  It  has  been 
generally  concluded  by  recent  medical  gi'aduates  who 
have  been  interviewed  that  it  is  not  desirable  for  the 

3 


24  Medicine  as  a  Profession. 

student  to  attempt  to  earn  anything  towards  his  ex- 
penses during  the  time  when  the  colleges  are  in  session. 

A  careful  study  of  a  number  of  records  has  led  to  the 
conclusion  that  the  cost  of  a  medical  education  must  be 
considered  as,  at  the  least,  $3,000  more  than  the  cost  of 
preparing  for  a  skilled  trade.  The  cost  for  female  stu- 
dents will  be  higher,  because  there  are  not  many  free 
scholarships  available  in  colleges  for  women  and  because 
the  income  from  vacation  earnings  will  likely  be  less 
than  for  male  students. 

Some  of  the  very  comfortable  reformers  who  believe 
in  regulating  all  the  affairs  of  men  by  legislation  could 
find  many  good  arguments  for  refusing  admission  to  a 
medical  school  those  who  cannot  prove  at  the  outset  that 
they  have  $3,000  in  available  cash  resources,  but  such 
would  also  have  excluded  from  the  study  of  medicine, 
Leopold  Augenbrugger,  the  son  of  a  poor  tavern  keeper, 
who  became  the  physician  to  the  empress,  Maria 
Theresa ;  Theodore  Schwamm,  the  fourth  of  the  thirteen 
children  of  a  poor  German  cobbler,  who  is  noted  as  the 
father  of  the  cell  doctrine;  Johannes  Muller,  the  son  of 
another  German  shoemaker  who  became  the  foremost 
physician  of  Germany  in  his  day;  and  James  Simpson, 
the  youngest  of  a  poor  Scotch  family  of  seven  who  is  the 
father  of  anesthetics.  Perhaps  one  half  of  those  at 
present  attending  medical  schools  are  successfully  pur- 
suing their  studies  in  spite  of  financial  worries. 

It  has  been  the  experience  of  many  who  borrowed  from 
friends  the  greater  part  of  the  necessary  $3,000  and 
took  out  life  insurance  policies  for  that  amount  to  pro- 
tect their  creditors  in  case  of  their  death,  that  by  the 
age  of  thirty  they  were  enabled  to  repay  their  loans  with 
interest,  and  it  may  well  be  considered  whether  it  would 


The  Financial  Eequieements.  25 

not  have  been  as  well  for  them  if  they  had  worked  and 
saved  for  a  few  years  before  entering  upon  medical 
school^  thus  bringing  a  larger  maturity  to  their  studies, 
incurring  smaller  obligations  and  being  perhaps  as  far 
at  the  age  of  thirty  as  if  their  educational  training  had 
been  continuous. 

One  ambitious  young  man  who  spent  the  vacations 
of  his  college  course  in  selling  subscription  books  secured 
a  position  as  a  district  manager  with  his  employers  and 
from  this  employment  he  was  able  to  make  enough  dur- 
ing his  vacations  while  attending  the  medical  college 
to  provide  for  all  his  expenses.  At  the  end  of  his  col- 
lege course  he  went  back  to  his  college  and  organized 
selling  squads  among  the  students  and  directed  these 
squads  during  his  vacations  while  taking  his  medical 
course. 

Another  young  man  graduating  out  of  the  same  class 
went  into  the  office  of  a  manufacturer  of  medical  sup- 
plies expecting  to  work  a  few  years  before  going  to 
medical  college.  His  work  was  so  satisfactory  that  he 
was  soon  started  on  the  road  as  a  salesman.  He  applied 
himself  so  energetically  to  his  work  that  within  three 
years  he  was  able  to  save  enough  for  his  entire  medical 
course.  In  addition  to  his  earnings  he  secured  an  ex- 
perience which  gave  him  a  most  helpful  outlook  over  the 
professional  field. 

A  physician  who  has  a  lucrative  practice  as  a  special- 
ist in  nervous  diseases,  when  interviewed,  gave  this 
story.  As  a  country  boy  he  drifted  to  the  city  to  make 
his  fortune.  For  want  of  anything  else  he  accepted 
a  place  as  a  waiter  in  a  restaurant,  and  later  secured 
work  in  the  dining-room  of  a  large  hotel.  This  experi- 
ence recommended  him  for  a  better  paying  position  as 


26  Medicine  as  a  Proeession. 

an  attendant  at  a  sanitarium  in  which  he  was  able  to 
earn  good  wages  and  save  considerable  money.  The  phy- 
sician in  attendance  being  attracted  by  the  way  in  which 
he  handled  the  patients  advised  him  to  take  up  the  study 
of  medicine.  By  the  time  he  was  twenty-five  he  had 
saved  enough  money  for  his  medical  course  and  had  ad- 
vanced himself  in  his  studies  so  as  to  be  able  to  meet  the 
requirements  for  admission  to  the  medical  school. 

A  young  man,  now  thirty  years  old,  who  holds  a  posi- 
tion in  a  government  laboratory  with  a  $2,750  salary,  ex- 
plained that  during  college  he  had  specialized  in  biology 
and  after  graduation  accepted  a  position  as  teacher  of  the 
subject  in  a  city  high  schood,  which  he  held  three  years, 
meanwhile  doing  some  of  the  required  medical  college 
work  so  that  he  was  able  to  graduate  after  two  years  of 
regular  attendance. 

A  young  colored  man  who  supported  himself  by  work- 
ing as  a  waiter  in  a  boarding  house  while  he  was  taking  a 
special  college  course  in  chemistry,  worked  as  an  assist- 
ant in  a  chemical  laboratory  for  a  few  years  after  his 
graduation  from  college,  saving  about  half  of  the  money 
necessary  for  his  medical  course  and  attracting  the 
favorable  attention  of  an  employer  who  volunteered  to 
make  him  a  loan  to  meet  his  additional  financial  needs. 

A  young  Hebrew  who  graduated  from  one  of  our 
medical  colleges  with  credit,  in  1914,  had  landed  with 
an  older  brother  in  this  country  at  the  age  of  sixteen 
with  a  fairly  good  elementary  education.  His  eyesight 
was  not  good,  he  could  not  speak  the  language  of  a 
strange  land,  but  he  secured  admission  to  a  city  high 
school  on  the  strength  of  his  school  credentials,  and  not 
only  maintained  creditable  standing  while  attending 
this  school  but  supported  himself  by  serving  a  news- 


The  Financial  Eequirements.  27 

paper  route  mornings  and  evenings,  working  from  four 
in  the  morning  to  ten  in  the  evening.  In  addition  to 
paying  his  share  of  the  modest  quarters  which  the  two 
brothers  occupied  he  paid  for  two  suburban  lots  on  the 
installment  plan.  When  he  was  ready  to  enter  the 
medical  college  he  sold  these  two  lots  for  $1,200  and 
with  the  assurance  of  support  from  his  brother  entered 
upon  his  medical  course  with  no  special  worries  about 
the  sources  of  his  income. 

A  young  woman,  who  after  graduating  from  high 
school  decided  to  take  up  medicine,  prepared  herself  as 
a  stenographer  and  acquired  an  experience  which  recom- 
mended her  for  a  position  as  stenographer  to  the  dean 
of  a  medical  college.  While  serving  in  this  position 
she  was  able  to  take  occasional  lecture  courses  and  after 
she  entered  the  medical  school  as  a  regular  student 
she  made  a  considerable  part  of  her  expenses  by  selling 
typewritten  copies  of  her  lecture  notes  to  other  students. 

It  is  usually  not  difficult  for  young  men  and  women 
to  obtain  remunerative  work  as  attendants  at  hospitals 
and  sanitariums.  This  kind  of  work  gives  the  prospec- 
tive medical  student  a  chance  to  test  his  fitness  for  the 
peculiar  requirements  of  the  profession  and  at  the  same 
time  makes  it  possible  for  him  to  earn  something  more 
than  he  would  earn  in  those  occupations  which  are  ordi- 
narily open  to  those  without  any  special  training.  In 
another  chapter  there  is  given  a  list  of  such  institutions 
in  different  parts  of  the  country  to  which  application 
can  be  made. 


CHAPTEE  V. 

Financial  Eewaeds. 

The  exceptional  few,  who  are  impelled  to  take  up  this 
profession  because  they  are  endowed  with  such  a  rare 
combination  of  native  talents  as  to  find  that  the  routine 
of  the  physician  makes  to  them  a  special  appeal,  will  be 
sure  to  succed  and  to  find  the  calling  so  remunerative 
and  satisfying  that  it  would  have  been  a  misfortune  to 
them  to  have  permitted  themselves  to  be  drawn  to  any- 
thing else ;  but  the  average  man  at  the  outset  will  want 
to  know  what  he  may  expect  in  the  way  of  monetary 
returns  from  his  labors  and  for  the  time  and  money 
which  he  is  called  upon  to  expend  in  making  his  prepa- 
ration. 

No  definite  information  in  regard  to  the  earnings  of 
physicians  is  available.  The  Medicol  World  estimates 
that  in  1902  there  were  in  the  United  States  100,000 
physicians  whose  average  income  was  $1,000  a  year; 
20,000  averaging  $2,000;  8,000  making  an  average  of 
$3,000 ;  not  over  2,000  reaching  the  $5,000  a  year  mark ; 
only  1,500  averaging  $10,000;  200  reaching  $20,000; 
perhaps  100  specialists  making  $25,000  apiece;  and  not 
over  100  who  could  claim  $30,000  or  more. 

This  would  mean  average  earnings  of  between  $1,000 
and  $1,500,  or  stated  in  another  way,  an  average  ex- 
penditure for  medical  services  for  each  man,  woman  and 
child  of  $2.20  per  year,  which  is  perhaps  not  far  wrong. 

Th€^  average  salaries  of  the  374  full  and  part  time 

28 


Financial  Rewards.  29 

physicians  employed  by  the  city  of  New  York  in  1912 
were  $1,300.  Some  of  these  gave  their  entire  time  to  the 
public  service  and  a  comparatively  few  remained  in  the 
service  for  any  number  of  years;  four  of  them  after  an 
average  service  of  seventeen  years  had  attained  annual 
salaries  of  $2,550;  seven,  averaging  fourteen  years  of 
service,  had  attained  to  averages  of  $3,000. 

The  Bureau  of  Standards  of  the  same  city,  after  a 
careful  investigation  in  1915,  recommended  the  follow- 
ing schedules  of  pay  for  physicians  in  the  municipal 
service:  medical  internes  in  hospitals  and  institutions 
with  maintenance  $240  for  the  first  year  and  $360  for 
the  second;  assistant  physicians  in  institutions  with 
maintenance,  from  $900  with  annual  increases  of  $120 
to  $1,380;  senior  physicians  from  $2,520  with  annual 
increases  of  $240  to  $3,480;  and  for  part-time  services 
averaging  not  less  than  eighteen  hours  per  week,  $1,500 
with  annual  increments  of  $120  to  $2,100;  medical 
superintendents  and  chief  physicians,  $2,780  to  $4,680. 

In  1914  the  authorities  of  Harvard  University  com- 
piled from  answers  to  inquiries  sent  to  graduates  the 
following  table  of  average  total  earnings  in  law  and 
medicine : 

Years  Out  of 

ProfCBslonal  Law.  Medicine. 

School  Average  Earnings.  Average  Earnlnga 

1 $664 $623 

2 1,110 909 

3 1,645 1,301 

4 2,150 1,681 

5 2,668 2,005 

6 3,118 2,410 

7 3,909 2,935 

8 4,426 3,227 

9 5,321 3,636 

10 5,325 3,789 


30  Medicine  as  a  Peofession". 

This  means  that  those  who  replied,  at  the  end  of  their 
tenth  year  of  graduation,  had  earned  during  that  year : 
in  law,  an  average  of  over  $5,000,  and  in  medicine,  less 
than  $4,000.  From  the  small  number  of  replies  which 
had  been  received  from  the  ten  year  men  in  law,  one 
may  be  led  to  infer  that  perhaps  neither  the  less  suc- 
cessful law}^ers  nor  those  who  had  given  up  law  for 
business  answered  the  inquiries.  These  tables  are  more 
suggestive  than  informing,  since  in  either  case  they 
represent  returns  only  from  fractions  of  the  groups 
studied. 

The  average  full-time  pay  of  all  the  male  teachers  in 
the  high  schools  of  cities  having  over  250,000  of  popu- 
lation was  $1,839  in  1912.  While  it  is  true  that  many 
persons  in  the  public-school  service  later  take  up  medi- 
cine, comparatively  few  doctors  leave  their  profession 
to  enter  teaching,  although  a  change  from  medical  prac- 
tice to  some  departments  of  educational  work  is  quite 
easy  in  most  of  the  cities.  This  means  that  the  practice 
of  medicine  brings  more  satisfying  rewards  than  this 
other  line  of  public  service  of  which  we  have  definite 
information  regarding  the  monetary  returns  and  that 
taking  the  country  as  a  whole  we  would  expect  for  the 
fairly  well-established  physician,  in  country  districts  and 
villages,  net  earnings  of  from  $1,000  to  $3,000;  in  the 
smaller  cities,  from  $1,000  to  $2,000;  in  the  larger 
cities,  from  $1,500  to  $4,000 ;  with  much  larger  returns 
for  the  unusually  successful  men. 

Approaching  this  problem  from  another  side,  we  note 
the  age  distribution  of  physicians  and  surgeons,  as  given 
in  the  census,  indicates  that  the  proportion  of  physicians 
over  forty-five  years  of  age  is  larger  than  the  proportion 
of  such  persons  in  other  professions.     This  means  that 


Financial  Eewards.  31 

a  large  proportion  of  those  who  enter  upon  the  practice 
of  medicine  remain  in  the  profession,  although  from  the 
very  nature  of  the  physician's  position  in  society  and  his 
opportunity  to  become  acquainted  with  men  of  affairs 
one  would  think  that  it  would  be  as  easy  for  him  to 
make  profitable  business  connections  as  it  is  for  lawyers. 

According  to  a  very  careful  study  made  by  the  Journal 
of  the  American  Medical  Association,  the  2,205  physi- 
cians whose  death  was  noted  in  the  columns  of  that 
periodical  for  1914  had  attained  an  average  age  of  be- 
tween sixty  and  sixty-one  years  and  their  average  num- 
ber of  years  of  practice  was  nearly  thirty-four.  This 
means  that  they  eiitered  upon  practice  at  about  the  age 
of  twenty-six,  and  assuming  $3,000  as  the  cost  of  their 
medical  education,  it  would  seem  that  if,  during  each 
year  of  their  productive  period,  they  had  laid  aside  $200 
the  principal  and  the  interest  on  their  outlay  would  have 
been  more  than  repaid.  Taking  this  amount  out  of 
their  earnings  it  is  more  than  likely  that  the  average  net 
earnings  of  physicians  as  a  class  will  for  this  productive 
period  of  thirty-four  years  still  be  double  the  net  earn- 
ings of  the  man  who  spent  about  as  much  time  in  learn- 
ing one  of  the  skilled  trades  and  whose  productive  period 
is  very  much  shorter. 

It  will  be  claimed  that  the  physician  has  many  ex- 
penses. Unlike  the  lawyers  most  of  the  physicians  have 
their  offices  in  their  own  homes.  Their  travelling  ex- 
penses are  much  smaller  than  those  of  the  men  engaged 
in  the  engineering  professions.  While  it  must  be  con- 
ceded that  the  law  offers  more  large  prizes  than  medicine 
it  is  doubtful  whether  any  of  the  scientific  professions 
offer  more  opportunities  for  securing  unusual  financial 
rewards. 


CHAPTER  VI. 

Pkospects. 

Certain  economists  claim  that  before  any  man  under- 
takes to  invest  time  and  money  in  securing  his  special 
training  for  any  vocation  he  should  make  sure  that  the 
particular  vocation  is  not  overcrowded  and  that  there  is 
a  public  demand  for  the  services  of  one  more  trained  man 
or  woman  in  the  field  which  he  is  thinking  of  entering. 
'On  the  other  hand  it  must  be  noted  that  very  few  per- 
sons who  prepare  themselves  for  gainful  occupations  or 
incur  expenses  for  engaging  in  producing  marketable 
commodities  have  any  assurance  in  advance  of  a  demand 
for  their  services  or  a  market  for  their  products. 

It  is  well  enough  however  to  try  to  find  out  what 
statistics  have  to  say  about  the  prospects  for  remunera- 
tive service  in  this  profession.  For  the  entire  United 
States  there  were  in  1890,  167  physicians  and  surgeons 
per  each  100,000  of  population;  in  1900,  174;  in  1910, 
165.  For  the  ten  largest  cities  in  the  country  taken 
together  there  were  in  1906,  236;  and  in  1910,  210 
male  and  female  physicians  per  100,000  of  population. 
Compared  with  100  or  less  for  most  of  the  European 
countries,  and  142  registered  physicians  per  100,000 
for  London  in  1911,  there  seem  to  be  indications  that 
the  current  notion  that  the  field  is  oversupplied  is  well 
founded.  This  disparity  in  the  number  of  physicians 
in  different  countries  may  be  partially  explained  by  the 
methods  of  the  census  takers  of  this  country,  who  enroll 

32 


Prospects.  33 

every  person  who  reports  himself  as  a  physician,  as 
such,  without  considering  whether  he  is  actually  en- 
gaged in  practice,  or  duly  licensed  and  registered.  More 
care  has  been  observed  in  this  respect  in  the  last  census. 

In  determining  whether  the  number  of  physicians  is 
greater  than  the  actual  needs  of  the  country,  several 
things  must  be  taken  into  consideration.  A  careful 
observer  with  a  large  acquaintance  among  medical  men 
is  of  the  opinion  that  in  this  country  20  per  cent,  of 
those  who  graduate  never  practice  medicine;  some,  be- 
cause they  entered  upon  their  preparation  without  any 
appreciation  of  the  real  significance  of  medicine  as  a 
career;  others,  because  they  early  discovered  that  medi- 
cine is  not  a  get-rich-quick  enterprise  if  practiced  ac- 
cording to  sound  ethical  standards,  nor  even  an  easy 
way  of  making  a  living.  Some,  even,  if  they  take  up 
other  callings  retain  the  title  of  doctor  and  are  so 
classed.  In  determining  the  chances  for  success  in  a 
given  locality,  it  must  be  considered  that  from  10  to  20 
per  cent,  of  the  registered  physicians  have  retired  from 
practice  or  are  among  those  who  while  not  actively  so 
engaged,  minister  to  the  wants  of  a  few  families  or 
patients  of  many  years  of  standing. 

After  making  due  allowance  for  all  these  factors,  a 
full  consideration  of  these  statistics  would  seem  to  force 
us  to  the  conclusion  that  on  account  of  the  activities  of 
the  too  numerous  medical  colleges  the  number  of  grad- 
uates has  been  in  excess  of  the  normal  demands ;  this  is 
reflected  in  the  decrease  of  the  enrollment  in  the  med- 
ical colleges  in  recent  years  although  a  part  of  the  de- 
crease must  be  attributed  to  the  higher  requirements 
for  admission.  This  tendency  is  to  be  noticed  in  the 
following  table : 


34  Medicine  as  a  Profession. 

1880.   1890.   1900.   1910.   1915. 

Number  of  students  in  attend- 
ance upon  medical  colleges 
per  100,000  of  population...   23         24         33         23         14 

Number  of  graduates  per  100,- 

000  of  population 6  7  7  5  3 

The  apparent  oversupply,  as  compared  with  other 
countries,  has  been  due  to  the  greater  freedom  which 
persons  of  all  classes  have  in  taking  up  this  work,  and 
the  oversupply  had  led  to  such  competition  for  business 
as  to  make  of  our  people  probably  the  best  served  nation 
in  the  world  in  this  respect.  We  may  conclude  that  for 
the  ordinary  normal  demands  of  the  well-organized  and 
prosperous  large  city  or  the  smaller  city  with  its  con- 
tiguous country  population,  a  ratio  of  from  150  to  180 
per  100,000  of  population  is  not  excessive. 

From  1902  to  1912  the  average  death  rate  among 
physicians  was  15.93  per  1,000;  so  that,  according  to 
these  figures,  approximately  2,500  new  medical  gradu- 
ates are  needed  each  year  to  take  the  places  of  those  who 
drop  out  of  the  ranks  on  account  of  death.  Considering 
also  the  growth  of  the  population  and  the  larger  needs 
of  the  under-supplied  communities  as  they  become  more 
prosperous  and  considering  particularly  the  increased 
demand  by  the  industries  for  the  medical  supervision  of 
workers  and  .the  rapidly  growing  movement  for  organ- 
ized public-health  service  we  must  conclude  that  the 
present  output  of  3,500  medical  graduates  every  year  is 
not  excessive. 

By  personal  interviews  with  many  physicians  in  sev- 
eral of  our  large  cities  some  very  conflicting  testimony 
on  this  point  was  collected.  While  the  committees  of 
medical  societies  agree  generally  that  there  is  an  over- 


Prospects.  35 

supply  of  doctors,  a  study  of  the  progress  of  young 
graduates  seemed  to  lead  to  different  conclusions.  The 
explanation  seems  to  lie  in  the  fact  that  in  some  of  these 
cities  the  American  elements  of  the  population  are  not 
increasing  while  the  number  of  American  physicians  is 
increasing.  On  the  other  hand,  the  rapid  increase  in 
some  of  the  foreign  elements  of  the  population  whose 
families  generally  prefer  physicians  of  their  own  race 
who  understand  their  own  language,  habits  and  customs 
has  contributed  to  the  prosperity  of  men  of  particular 
nationalities  who  have  taken  up  this  profession. 

Turning  aside  from  the  statistics  of  the  subject  and 
casting  away  the  offhand  opinions  of  old  physicians, 
who,  in  common  with  men  in  other  walks  of  life,  are 
sure  that  things  with  them  and  in  their  work  are  be- 
coming worse  every  day,  let  us  examine  into  some  con- 
crete cases,  after  the  manner  of  physicians  themselves 
who  try  to  find  general  truths  in  particulars. 

Twenty  years  ago  the  son  of  a  mechanic  consulted 
his  teacher  about  the  advisability  of  taking  up  medicine. 
Tie  was  referred  to  the  physician  of  his  family  and  to 
his  teacher's  own  physician.  Both  of  them  advised 
against  it.  The  young  man  was  of  average  mental 
ability,  but  with  a  capacity  for  steadiness  and  patient 
plodding.  In  spite  of  the  advice  given  him  he  entered 
a  medical  college  with  what  would  at  this  time  be  con- 
sidered an  inadequate  preparation.  The  college  which 
he  entered  is  one  of  those  which  has  since  been  com- 
pelled to  close  on  account  of  unfavorable  criticisms  by 
an  investigating  committee. 

The  young  man  settled  in  a  western  city  with  a  popu- 
lation of  200,000  and  over  400  physicians;  moreover, 
having  no  money  to  keep  down  expenses  he  opened  a 


36  Medicine  as  a  Profession. 

shop  in  a  poorer  section  of  the  city.  To  his  former 
teacher  on  a  recent  visit,  he  deplored  the  fact  that  he 
had  not  permitted  himself  to  be  advised  against  the 
profession  and  gone  into  business.  He  was  disap- 
pointed because  of  what  he  had  not  accomplished  and 
allowed  himself  to  be  unhappy  in  his  disappointment. 

"Let  us  look  at  it  in  this  way/'  said  his  visitor,  as 
they  sat  in  his  comfortable  study  overlooking  the  city. 
"How  does  your  success  compare  with  the  records  of 
the  other  fourteen  boys  who  were  graduated  from  the 
village  high  school  with  you?" 

He  concluded  his  review  of  their  several  histories, 
with  which  he  had  been  fairly  well  acquainted  through 
his  frequent  visits  to  the  old  home,  with  the  statement 
that  he  didn't  think  that  his  wife  would  trade  him  off 
for  any  one  of  them. 

Within  the  last  year  the  writer  had  a  visit  from  one 
who  had  been  a  classmate  with  him  in  a  country  acad- 
emy. He  was  a  young  man  who  had  no  means,  had 
enjoyed  limited  social  advantages  but  had  inherited  a 
strong  physical  constitution  and  the  conviction  that  he, 
himself,  must  be  the  architect  of  any  fortunes  which  he 
could  ever  hope  to  enjoy.  He  entered  a  medical  college 
with  the  minimum  preparation  required  by  the  times 
and  was  graduated  from  a  course  which  later  had  to  be 
extended  upon  the  demand  of  the  public  authorities. 
He  settled  in  a  small  eastern  town  which  according  to 
the  conclusions  of  our  statistical  review  was  at  the  time 
overstocked  with  medical  men.  In  the  course  of  thirty 
years  he  had  so  gradually  grown  into  a  competence  that 
he  had  not  recognized  his  own  financial  success.  He 
had  lived  in  comparative  comfort,  was  able  to  give  his 


Peospects.  37 

children  the  best  educational  and  social  advantages  and 
to  make  ample  provisions  for  his  own  old  age. 

The  change  in  the  personnel  of  the  medical  profession 
in  any  locality  is  well  illustrated  by  the  record  of  a 
connty  of  19,000  population  in  one  of  the  central  states. 
Twenty  years  ago  there  were  28  physicians  in  active 
practice;  today  there  are  27  active  and  9  retired  phy- 
sicians in  the  county,  while  the  population  remains 
approximately  the  same.  Only  6  of  the  physicians  who 
were  in  practice  twenty  years  ago  are  so  engaged  now. 
Nine  of  them  retired ;  two  moved  away  and  eleven  died. 
Seventy-six  newcomers  registered  within  the  twenty 
years,  and  only  21  of  these  are  now  in  practice  in  the 
county.  The  larger  number  of  those  who  removed 
could  not  establish  a  sustaining  practice ;  some  of  these 
were  incompetent  physicians  who  could  not  have  suc- 
ceeded anywhere,  but  the  others  established  themselves 
in  other  localities.  Those  who  had  the  patience  to  grow 
into  a  practice,  or,  in  other  words,  to  build  into  one,  suc- 
ceeded. The  schools  of  medicine,  regular,  homeopathic, 
eclectic  or  osteopathic,  are  important  factors  in  some 
localities,  and  are  worthy  of  consideration  as  possible 
factors  in  determining  success,  in  given  locations. 

The  action  of  Congress  in  placing  the  army  and 
navy  on  a  war  footing  will  call  for  such  a  large  number 
of  appointments  to  the  medical  service  as  to  influence 
favorably  the  prospect  of  recent  medical  graduates. 

One  of  the  foremost  surgeons  in  one  of  our  large 
cities  reports  that  his  earnings  in  his  first  year  were  less 
than  $500;  the  second  year,  $750;  the  third,  $1,500; 
reaching  in  the  seventh  year  to  $4,000;  upon  which, 
when  he  announced  to  his  associates  that  he  proposed 
to  take  a  short  time  to  study  and  after  that  to  devote 


38  Medicine  as  a  Profession. 

himseK  to  special  surgical  work,  he  was  advised  against 
doing  so  by  the  unanimous  voice  of  his  professional 
friends  and  yet  in  less  than  five  years  thereafter  he  had 
passed  annual  earnings  of  $10,000. 

Taking  all  things  into  consideration  and  comparing 
the  prospects  in  this  field  with  the  prospects  in  other 
lines  of  effort  in  which  men  are  dependent  upon  the 
patronage  of  their  fellows  for  their  support,  we  must 
conclude  that  the  man  who  has  faith  in  himself,  a  will- 
ingness and  the  energy  to  prepare  himself  by  the  mas- 
tery of  the  best  which  his  time  affords,  need  have  little 
fear  of  acquiring  the  durable  satisfactions  of  life  in  this 
calling,  but  he -must  do  what  other  men  do  to  win  suc- 
cess :  offer  his  clients  a  superior  service  and  then  educate 
them  to  an  appreciation  of  that  service. 

The  table  given  in  the  appendix,  showing  the  number 
of  physicians  per  100,000  of  population  in  the  several 
states  and  cities,  may  be  of  value  to  young  physicians  as 
indicating  what  sections  of  the  country  are  oversupplied 
and  what  parts  are  undersupplied. 


o 

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X 


CHAPTEE  YII. 

Systems  of  Medicine 

Just  as  we  have  parties  in  politics  and  sects  in  reli- 
gion, we  have  schools  teaching  different  systems  of  medi- 
cine. One  of  the  first  questions  to  be  determined  in  the 
selection  of  a  medical  college  in  which  to  prepare  for  the 
practice  of  this  profession  is  the  system  of  medicine 
upon  which  the  candidate  desires  to  base  his  medical 
education.  The  four  principal  systems  or  schools  are 
the  so-called  regular  or  allopathic,  the  homeopathic,  the 
eclectic  and  the  osteopathic.  It  may  be  taken  for  granted 
that  the  teachers  and  practitioners  of  each  of  these  sev- 
eral systems  are  honest  and  sincere  in  their  belief  that 
their  own  is  the  best. 

In  the  conquest  of  every  extensive  field  of  human 
knowledge  we  find  like  diversities  of  views  and  meth- 
ods. In  the  development  of  the  flying  machine,  one 
experimenter  succeeds  with  a  monoplane;  he  declares 
that  it  is  the  only  satisfactory  machine ;  another  achieves 
wonders  with  a  biplane  and  another  establishes  an  air- 
line with  a  Zeppelin  who  would  fear  to  trust  himself  to 
the  smaller  machines,  which  he  regards  as  mere  toys. 
Gradually  men  combine  the  best  features  of  each  of  the 
several  machines  or  use  one  or  the  other  according  to 
their  needs.  So  it  is  in  farming ;  one  man  speaks  of  the 
profits  which  he  made  with  diversified  crops  and  another 
believes  that  the  greatest  success  comes  to  him  who  would 
specialize  in  fruit  or  grain  or  live  stock.  One  manu- 
4  39 


40  Medicine  as  a  Profession". 

facturer  builds  up  an  efficient  working  machine  by  using 
a  time  basis  of  paying  wages;  another,  equally  success- 
ful by  compensating  his  men  on  the  basis  of  piece  work, 
declares  that  a  uniform  daily  wage  would  demoralize  his 
force  and  bankrupt  him.  Their  ignorance  of  what  lies 
outside  of  their  own  experience  warps  their  judgment. 
A  young  man  who  would  decide  upon  taking  up  some 
one  system  of  medical  practice  or  another  must  make 
due  allowances  for  the  prejudices  of  those  whom  he 
consults. 

With  the  progress  of  medicine,  these  several  schools 
have  not  been  slow  to  appropriate  to  themselves  the  best 
of  the  others  and  while  it  is  desirable  for  a  young  man, 
at  the  outset,  to  know  in  general  the  essential  principles 
of  each,  yet  he  will  not  go  far  wrong  if  he  assumes  that 
the  spirit  with  which  he  takes  up  a  system  of  medicine 
and  the  oneness  of  purpose  vrith  which  he  pursues  his 
preparation  will  mean  more  to  him  than  the  selection 
of  a  particular  school. 

The  theory  and  philosophy  and  only  the  very  general 
differences  of  the  several  systems  can  be  enumerated. 

The  Regular  School. 

The  art  of  healing  had  made  much  progress  long  be- 
fore the  science  of  medicine  had  developed.  By  ex- 
perience, men  learned  that  certain  kinds  of  treatment 
and  certain  medicines  were  effective,  and  in  the  course 
of  time  medical  men  accumulated  vast  stores  of  knowl- 
edge which  was  carefully  handed  down  from  one  gen- 
eration to  another  and  as  science  advanced  the  reasons 
for  the  effectiveness  of  their  methods  became  known; 
but  whether  the  new  candidate  for  the  profession  studied 
in  the  schools  or  with  the  men  whose  offices  they  entered 


Systems  of  Medicine.  41 

as  students,  in  his  education  he  was  chiefly  concerned 
with  equipping  himself  with  the  traditional  knowledge 
of  the  profession,  and  in  this  way  the  so-called  regular 
school  was  developed. 

The  impression  must  not  go  abroad  that  all  other 
schools  are  irregular  or  unauthorized  or  unrecognized 
})y  law.  In  the  eyes  of  the  law  any  duly  licensed  phy- 
sician is  considered  a  regular  physician. 

The  physician  of  the  regular  school  is  the  empiric  of 
his  profession.  He  determines  upon  a  treatment  or  pre- 
scribes a  medicine  in  a  particular  case  upon  the  clinical 
evidence  which  he  has  of  the  value  of  the  special  treat- 
ment or  the  particular  medicine  and  the  results  which 
have  been  secured  by  others ;  so,  if  any  particular  course 
proves  effective  in  given  diseases,  the  fact  is  noted  and 
taught,  and  thereafter  others  are  justified  in  their  own 
judgment,  the  opinion  of  their  fellows  and  in  the  eyes 
of  the  law  in  using  the  same  in  similar  cases.  This  is 
empirical  prescribing  and  it  may  be  said  that  no  test 
is  so  good  or  so  reliable  as  the  test  of  experience. 

The  regular  school  has  fostered  the  introduction  of 
many  therapeutic  agents.  As  a  result  of  the  experi- 
ments in  the  laboratories  a  large  number  of  refined, 
positive  and  valuable  agents  have  been  developed.  "We 
have  the  antitoxin  for  diphtheria,  another  antitoxin  for 
tetanus  and  some  forty  serums,  vaccines,  bacterins,  which 
experience  may  later  approve  or  reject. 

The  regular  physician  naturally  will  lay  great  stress 
upon  the  physical  diagnosis  of  disease  because,  in  order 
that  he  may  be  able  to  assure  himself  that  he  is  using 
the  traditional  treatment,  he  must  be  able  to  diagnose 
diseases  and  recognize  the  description  of  these  diseases 
as  they  appear  in  his  treatises;  and  if,  perhaps,  the 


42  Medicine  as  a  Profession. 

therapeutic  or  treatment  side  of  the  regular  practitioner 
has  not  kept  pace  with  his  ability  in  physical  diagnosis, 
the  advancement  even  in  these  lines  has  been  almost 
revolutionary  in  the  past  seventy  years.  Formerly  the 
doses  of  medicine  were  crude  and  massive;  today  they 
are  put  up  in  the  most  palatable  vehicles,  in  sweet  syrups, 
elixirs,  sugar-coated  pills,  tablets,  and  aseptic,  hypo- 
dermic flasks.  The  dose  is  very  much  smaller  and  it  is 
seldom  that  a  maximum  dose  is  given  upon  the  old  "  kill 
or  cure"  dosage. 

The  practitioner  of  the  old  school  makes  his  diagnosis 
of  disease ;  selects  his  treatment  according  to  his  experi- 
ence in  similar  cases;  writes  out  prescriptions  to  be 
filled  by  the  regular  pharmacists  wherever  these  are 
available,  and  considers  the  main  object  of  his  treatment 
the  restoration  of  his  patient  to  health  and  only  second- 
arily the  advancement  of  medical  science. 

As  a  judge  allows  his  decisions  in  diflBcult  cases  to 
be  governed  by  precedents  long  after  social  changes  have 
made  them  obsolete,  so  the  physician  oftentimes  is 
tempted  to  protect  himself  from  criticism  in  possibly 
unfavorable  results  by  taking  refuge  in  the  traditions 
of  his  profession  and,  moreover,  it  is  generally  easier 
to  depend  upon  precedent  in  determining  a  course  of 
action  than  it  is  to  work  out  a  complicated  problem 
through  the  slow  processes  of  reasoning. 

The  Homeopathic  School. 

Society  protects  itself  against  anarchy  and  sudden 
revolutions  by  its  conservatism.  The  ranks  of  the  ultra- 
conservatives  are  uncomfortable  places  for  the  reformers ; 
therefore  the  pioneers  of  progress  find  it  wise  to  set  up 
independent  organizations  to  promote  their  views.    Such 


Systems  of  Medicine.  43 

independent  organizations  may  die  in  the  course  of  time 
or  parallel  the  work  of  the  older  ones,  displace  them  or 
force  their  views  upon  them.  In  medicine  these  new 
schools  have  heen  designated  as  "  irregular.'^  The 
strongest  and  most  influential  of  these  are  the  practi- 
tioners of  the  homeopathic  system,  which  is  generally 
spoken  of  as  the  "sugar  pill"  medicine. 

This  nickname  originated  from  the  fact  th,at  in  very 
many  instances  the  homeopathic  physician  saturated 
sugar  pellets  or  disks  with  the  medicine  which  he  pre- 
scribed, merely  as  a  matter  of  convenience.  Today  all 
physicians  use  pills  and  tablets,  sugared  throughout  or 
sugar  coated.  Then  again  the  small  dose  of  medicine 
which  the  homeopathic  physician  prescribes  has  been 
held  up  to  ridicule  by  the  old  school  for  years,  yet  today 
the  most  advanced  men  of  all  schools  use  small  doses  as 
compared  with  the  drastic  dosing  of  a  half  century  ago. 

Women  are  often  heard  to  remark :  "  We  have  a  home- 
opathic physician  for  the  children  because  they  take 
his  medicine ;  it  is  not  so  strong ;  but  for  adults  stronger 
medicine  is  better." 

The  fact  that  children  do  get  sick,  and  that  about  two- 
thirds  of  all  illness  is  during  infancy  and  childhood, 
would  be  strong  argument  in  favor  of  the  homeopathic 
system.  The  parents  do  want  palatable  medicine  for 
the  children,  and  this  has  been  the  cause  of  the  adoption 
of  a  homeopathic  system  in  many  homes  for  the  children. 

The  children  mature  and  as  a  rule  they  continue  to 
favor  the  family  physician  of  their  childhood.  Many 
families  have  adopted  this  practice  for  trivial  cases  and 
later  finding  it  effective  in  serious  cases  they  have  been 
led  to  adopt  it  for  the  adult  members  as  well  as  for  the 
infants.       This  is  often  done  without  going  into  the 


44  Medicine  as  a  Profession-. 

theory  of  the  practice,  or  without  knowing  anything  of 
homeopathy,  except  that  the  physicians  give  palatable 
medicines  in  small  doses,  and  cure  as  promptly  as  the 
physicians  of  other  systems.  They  realize  that  the 
danger  of  over-dosing  is  minimized. 

The  theory  upon  which  a  homeopathic  physician 
reasons  is  this:  Nature  is  reacting  against  some  poison 
and  the  fever  is  an  index  to  its  efforts  to  fight,  or  throw 
off,  the  poison  accumulated  within  the  system  as  a  result 
of  the  disease.  The  duty  then  is  to  prescribe  such  reme- 
dial agents  as  will  assist  nature  in  its  own  efforts. 

They  also  regard  pain  as  only  a  symptom  or  a  warning 
of  the  presence  of  some  disturbing  factor;  and  instead 
of  administering  an  opiate  to  make  the  patient  uncon- 
scious of  the  pain,  thereby  paralyzing  nature  in  its  own 
efforts  at  self  protection,  homeopathy  tries,  if  possible, 
to  remove  the  cause  or  to  aid  nature  in  its  efforts  to  do  so. 
If  it  be  a  foreign  body  piercing  the  flesh  it  is  removed 
mechanically.  If  it  is  some  offending  food  within  the 
stomach  that  causes  the  pain,  the  homeopathic  physician 
instead  of  giving  an  opiate  to  paralyze  the  nervous  sys- 
tem so  that  the  patient  may  become  unconscious  of  the 
disturbing  element,  calls  for  some  remedial  measure 
that  will  aid  nature  in  eliminating  the  disturbing  factor. 

The  homeopathic  school  tests  all  its  medicines  upon 
healthy  human  beings  before  using  them  upon  the  sick. 
Each  prover  takes  the  medicine  and  records  the  symp- 
toms that  develop  in  their  order  of  development.  All 
the  records  of  the  various  provers  are  taken  together  and 
the  symptoms  experienced  by  all  the  provers  are  recorded 
as  symptoms  produced  by  the  medicine. 

Such  tests  are  made  of  all  new  remedies  before  they 
are  added  to  the  armamentarium  of  the  physician.     In 


Systems  of  Medicine.  45 

this  way  all  fads  and  fancies  are  eliminated.  In  no 
field  or  vocation  are  fads  and  fancies  so  ready  to  present 
themselves  as  in  medicine.    The  cnre-alls  are  ever  with  us. 

In  the  United  States  about  one  out  of  every  seven 
physicians  practices  homeopathy.  This  ratio  varies  in 
different  communities.  This  school  has  about  20,000 
physicians,  and  nearly  all  of  these  are  in  private  prac- 
tice, hospital  and  corporation  work. 

In  the  army,  navy,  marine-hospital  and  public  health 
service  the  appointments  are  made  after  an  examination 
by  a  board  of  surgeons  already  in  the  service.  These 
examiners  are  "  regular  ^^  physicians  and  the  examina- 
tion is  one  conforming  to  the  practice  of  their  own 
school.  So  here  is  a  strong  argument  against  the  study 
of  homeopathy  by  any  young  man  who  aspires  to  serve 
in  the  army  or  navy,  or  for  that  matter  in  any  govern- 
ment service  in  which  examination  must  be  taken  be- 
fore a  board  composed  of  physicians  of  the  regular 
school. 

The  Eclectic  School. 

The  Eclectic  School  is  a  system  of  medicine  which 
arose  as  a  protest  against  the  nauseating,  heavy  dosing 
with  poisonous  dinigs  of  half  a  century  ago.  The  first 
N'ational  Eclectic  Medical  Association,  organized  in 
1848,  proclaimed  that  "disease  was  an  impairment  of 
life"  and  not  an  entity  to  be  removed  by  violent  and 
pernicious  drugs,  but  rather  by  a  conservative  and  sup- 
portive treatment  for  assisting  nature  to  restore  health. 
The  eclectic  school  has  insisted  upon  giving  a  small, 
pleasant,  palatable  dose,  with  the  object  of  assisting 
nature's  effort  to  restore  health,  instead  of  giving  the 
massive,  poisonous  doses  composed  of  concoctions  of  a 
number  of  drugs  that  too  often  hindered  nature. 


46  Medicine  as  a  Profession. 

Then  again  the  eclectics  do  a  great  work  in  the  inves- 
tigation and  in  the  preparation  of  medicinal  agents. 
The  fact  that  it  is  possible  to  obtain  such  wonderful 
results  with  small  non-poisonous  doses  of  medicines  is 
in  a  great  measure  due  to  their  careful  methods  of  pre- 
paring them.  Many  medicines  lose  their  therapeutic 
properties  through  careless  handling  in  the  crude  state 
and  through  careless  and  indifferent  methods  in  the 
preparation  of  the  tinctures.  It  is  to  the  credit  of  the 
newer  schools  that  the  utmost  care  is  taken  in  the  selec- 
tion of  the  medicinal  plants  to  be  used  in  the  manufac- 
ture of  tinctures,  and  that  all  plant  tinctures  are  made 
of  fresh  plants,  thus  retaining  all  the  effective  principles 
of  the  agent.  While  the  eclectics  do  use  remedies  pre- 
pared mostly  from  the  highly  organized  vegetable  king- 
dom, yet  they  do  not  depend  upon  them  solely.  They 
believe  that  the  curative  value  of  medicines  can  only  be 
positively  demonstrated  by  actual  clinical  testing  on  the 
sick,  and  therefore  it  does  not  matter  whether  the  medi- 
cines are  derived  from  the  vegetable  or  mineral  kingdoms. 

The  eclectic  school  believes  in  prescribing  remedies 
upon  systemic  or  specific  indications,  not  for  any  specific 
disease.  Take,  for  an  illustration,  pneumonia.  The 
physician  may  have  several  different  cases  of  pneumonia 
to  treat  and  he  may  prescribe  different  remedies  in  all 
cases.  If  the  patients  would  all  present  similar  symp- 
toms and  similar  conditions,  they  would  all  receive 
similar  remedies;  but  if  different  symptoms  manifest 
themselves  they  would  receive  different  remedies,  regard- 
less of  the  fact  that  all  are  pneumonia  cases.  The  eclec- 
tics treat  patients  and  not  diseases.  If  a  patient  has 
''a  flushed  face,  bright  eyes,  contracted  pupils,  increased 
heat  in  the  head  and  a  congested  headache,"  no  matter 


Systems  of  Medicine.  47 

what  the  disease  with  which  these  symptoms  are  asso- 
ciated, whether  pneumonia,  typhoid  fever,  la  grippe,  etc., 
the  same  remedy  would  be  selected  in  each.  This  makes 
a  safe  and  simple  prescription. 

This  school  does  not  look  with  favor  upon  the  exploi- 
tation of  all  kinds  of  animal  serums,  which  are  lauded 
as  "cure-alls'^  for  various  diseases,  for  the  reason  that 
prescribing  upon  the  specific  name  of  a  disease  is  disap- 
pointing, and  also  that  the  purity  of  sera  cannot  at  all 
times  be  vouched  for. 

In  private  practice  the  eclectic  will  find  many  good 
openings.  He  may  choose  a  place  where  he  would  like 
to  live,  apply  himself  to  his  profession,  and  he  will  suc- 
ceed.    This  is  especially  true  in  rural  districts. 

Osteopathy. 

This  system  of  treatment  or  adjustment  of  the  body 
in  the  sick  has  sprung  up  within  the  last  thirty  years. 
It  is  based  upon  the  theory  that  there  is  a  mechanical 
cause  for  all  ills  and  diseases.  The  cause  of  the  disease 
is  a  slipping  of  some  vertebrae  or  bones  which  impinge 
upon  some  spinal  nerves,  and  as  a  result  the  nerve  func- 
tion is  perverted,  resulting  in  excess  or  diminution  of 
the  blood  supply  to  some  organs. 

Abnormal  pressure  may  even  cause  disease  in  a  remote 
part  of  the  body  through  the  reflexes  or  the  sympathetic 
nervous  impulse.  The  osteopath  contends  that  these 
twists  or  subluxations  need  not  be  large  ones  in  order  to 
cause  physical  disturbances.  The  spots  of  contact  are 
very  small,  yet  cause  a  great  deal  of  disturbance  of  the 
nervous  system  aside  from  the  local  pain.  One  cannot 
overestimate  the  nervous  impulse  and  its  influence  in  the 
maintenance   of  metabolism  in   the  human   economy. 


48  Medicine  as  a  Profession-. 

Every  point  of  the  body  has  nerve  filaments  which  play 
their  part  in  the  whole  network  of  telegraphic  lines. 
The  vasomotor  nerves  practically  control  the  distribu- 
tion of  the  blood  supply  and  all  voluntary  actions,  while 
the  sympathetic  system  controls  to  a  large  extent  the 
internal  functions.  Many  physicians  believe  that  a  num- 
ber of  diseases,  especially  neuralgias,  are  due  to  pres- 
sure, or  irritation  of  the  nerve  affected ;  but  the  method 
of  manipulation  of  the  osteopath  for  the  relief  of  such 
pressure  is  distinctive  of  the  osteopathic  system. 

Other  schools  believe  with  the  osteopath  that,  after 
all,  nature  does  all  the  curing,  the  only  difference  being 
in  the  means  which  are  used  to  aid  nature.  "WTiatever 
is  best  in  all  treatment  is  that  which  will  aid  nature; 
sometimes,  check;  sometimes,  stimulate,  as  the  case  re- 
quires. The  patient  does  not  care  a  snap  for  theory, 
but  for  results,  and  the  osteopath  has  given  very  credit- 
able results  in  practice. 

There  are  about  8,000  practitioners  in  the  United 
States,  and  most  of  them  doing  well.  The  school  pos- 
sibly has  suffered  somewhat  by  the  low  standard  for- 
merly set  for  entrance  and  the  low  standards  or  lack  of 
standards  of  study,  as  a  result  of  which  a  number  of 
incompetent  practitioners  are  credited  to  the  school. 
Of  late  years  the  course  of  study  and  general  require- 
ment have  been  brought  up  to  the  standard  of  other 
medical  colleges,  and  this  has  developed  skilled  modern 
practitioners  who  study  bacteriology,  hygiene,  disin- 
fectants, surgery,  obstetrics,  etc.,  in  the  same  thorough 
way  as  the  students  of  the  regular  colleges. 

The  cost  of  tuition  and  other  expenses  are  about  the 
same  as  in  the  preparation  for  regular  practice. 


Systems  of  Medicine.  49 

The  osteopathic  practitioner  is  legalized  in  all  the 
states,  except  Maine. 

From  a  business  point  of  view  a  young  man  or  woman 
of  strong  personality  can  do  well  in  osteopathy.  The 
field  is  not  overcrowded.  People  are  generally  feeling 
kindly  towards  the  system  because  there  has  been  so 
much  irrational  empirical  dosing  with  syrups,  elixirs 
and  pills  until  "  they  are  sick  of  it.^^  The  osteopath  has 
been  able  to  extract  a  larger  fee  for  treatment  than  the 
general  practitioner  has  been  able  to  get  in  similar  cases. 

One  might  consider  here  the  opposition  that  a  young 
man  may  meet  in  practice.  The  regular  medical  pro- 
fession does  not  look  kindly  upon  the  osteopath,  and 
makes  matters  unpleasant  for  the  isolated  osteopath. 
This  feeling  is  not  so  much  that  they  do  not  recognize 
the  osteopath  as  a  legitimate  practitioner,  but  is  due 
more  to  the  questionable,  or,  as  they  call  it,  "  unethical " 
means  used  by  many  osteopaths  in  advertising.  Whether 
it  is  right  or  wrong  does  not  enter  into  the  question,  but 
medical  men  have  a  code  of  ethics  which  prohibits  ad- 
vertising and  which  establishes  the  relations  of  phy- 
sicians towards  each  other.  Where  the  osteopath  re- 
spects the  code  of  ethics  of  the  physician,  he,  too,  is 
respected  and  shown  the  same  fellowship. 

Unlicensed  Practitioners. 

There  are  other  schools  of  medical  and  drugless  heal- 
ing whose  promoters,  for  a  sufficient  fee,  promise  to 
equip  any  student  in  a  few  months  with  their  newly 
discovered  science;  and  there  are  those  who  under  the 
guise  of  religion  profess  that  by  the  mere  expression  of 
a  belief  in  their  peculiar  system,  the  believer  may  per- 
form miraculous  cures.     Eeputable  journals  carry  their 


50  Medicine  as  a  Profession. 

alluring  advertisements  and  it  is  fortunate  that  the 
common  sense  of  conservative  people  has  been  crystal- 
ized  into  laws  which  make  it  impossible  for  any  one  to 
become  a  licensed  practitioner  who  has  not  taken  the 
prescribed  training  as  described  in  the  next  chapter. 
One  contemplating  the  healing  profession  as  a  vocation 
should  select  one  of  the  systems  that  is  recognized  and 
legally  licensed,  and  after  this  decision  is  made,  should 
select  a  college  with  a  high  standard  of  efficiency. 


CHAPTER  YIII. 

The  Medical  Colleges  and  theik  Eequikements 
EOK  Ad:mission'. 

In  planning  for  a  medical  edncation,  consideration 
ninst  be  given  to  the  election  of  the  subjects  of  study 
in  the  high  school,  the  nature  of  the  work  which  should 
be  done  in  the  oSe  or  more  years  of  college  work  and 
the  selection  of  the  medical  college.  This  subject  has 
been  carefully  studied  within  the  past  few  years  by 
several  committees  composed  of  medical  practitioners 
and  teachers  of  medicine.  Prospective  students  will  do 
well  to  consider  the  reports  of  these  investigating  bodies, 
bearing  in  mind  that  in  order  to  get  the  approval  of 
committees  on  which  are  found  as  many  conservatives 
as  progressives,  such  reports  usually  give  the  summaries 
of  compromises  and  not  reflections  of  well-balanced 
ideals. 

These  minimum  standards,  however,  have  served  the 
purpose  of  furnishing  a  basis  for  the  classification  of 
medical  schools.  The  kind  of  training  that  any  pro- 
fessional school  can  give  will  depend  upon  the  character 
of  the  student  body  as  well  as  upon  the  kind  of  equip- 
ment and  the  professional  experience  and  standing  of 
the  teachers.  Moreover,  the  graduate  of  a  professional 
school  finds  that  his  initial  rating  in  his  profession  is 
made  for  him  by  the  students  who  have  been  graduated 
from  the  same  school  before  him.  It  is  good  policy, 
therefore,  to  attend  a  school  whose  graduates  are  rated 

51 


52  Medicine  as  a  Profession. 

high  in  the  profession,  and  it  is  safe  to  assume  that  the 
higher  the  standard  of  admission  for  students,  the 
better  the  grade  of  instruction  in  any  professional 
school. 

The  best  medical  schools  are  rapidly  adopting  the 
standards  of  admission  which  are  prescribed  by  the 
Committee  on  Education  of  the  American  Medical  Asso- 
ciation; and  it  is  likely  that  before  another  four  years 
have  passed,  most  of  the  medical  colleges  will  require 
at  least  two  years  of  college  work  in  addition  to  the 
four  years  of  training  in  the  high  school. 

The  recommendations  referred  to  require  that  a  stu- 
dent shall  have  had  a  full  four  years'  course  of  training 
in  an  accredited  or  approved  high  school  or  other  insti- 
tution of  the  same  grade,  or  that  he  shall  present  cer- 
tificates showing  that  he  has  passed  examinations  before 
a  properly  authorized  examining  board,  in  subjects  re- 
quired in  such  schools  covering  at  least  fourteen  units 
of  work,  each  unit  including  not  less  than  thirty-six 
weeks'  work  of  four,  or  five,  forty-minute  recitations 
per  week. 

The  recommendations  referred  to  prescribe  that  there 
shall  be  seven  units  which  shall  be  required  of  all  stu- 
dents and  which  may  be  elected  from  the  following: 
Eeading  and  Practice  of  English,  2;  Algebra  to  quad- 
ratics, 1;  Plane  Geometry,  1;  Elementary  French  or 
German,  2;  American  History  or  Civics,  1.  Two  units 
of  Greek  or  of  Latin  may  be  offered  in  place  of  the 
units  in  modern  languages. 

Seven  additional  units  may  be  selected  from  the  fol- 
lowing: Intermediate  Algebra,  -J;  Solid  Geometry,  J; 
Latin  Grammar  and  Composition,  1 ;  Caesar,  1 ;  Cicero, 
1 ;  Virgil,  1 ;  Nepos,  1 ;  Greek  Grammar  and  Composition, 


The  Medical  Colleges.  53 

1 ;  Homer,  1 ;  Xenophon,  1 ;  Intermediate  German  or 
French,  1;  Elmentary  Spanish  or  Elementary  Scandi- 
navian, 1 ;  Greek  and  Eoman  History,  1 ;  Medieval  and 
Modern  History,  1 ;  English  History,  1 ;  Botany  and 
Zoology,  1;  or  Biology,  1;  Chemistry,  1;  Physics,  1; 
Physiography,  -J;  Physiology,  -J;  (no  credit  shall  be 
given  for  science  courses  which  do  not  include  labora- 
tory work;)  Agriculture,  1;  Drawing,  1;  Manual  Train- 
ing, 1 ;  Music,  1 ;  Domestic  Science,  1. 

It  will  be  noted  in  the  table  given  in  the  appendix 
that  medical  colleges  are  even  now  beginning  to  require 
one  or  more  years  of  college  work,  and  that  the  leading 
medical  colleges  are  requiring  four  years  of  such  work. 

The  preliminary  college  year  should  include  for  a 
period  of  thirty-two  weeks  2  recitation  or  lecture  periods 
and  2  laboratory  periods  in  Physics ;  the  same  in  Chem- 
istry ;  2  recitation  periods  and  2  laboratory  periods  or  3 
recitation  periods  and  1  laboratory  period  in  Biology; 
and  3  or  4  recitation  periods  per  week  in  advanced 
French  or  German. 

Work  is  to  be  accepted  only  if  taken  in  a  standard 
college  and  not  as  a  postgraduate  course  in  a  high 
school.  If  given  as  a  premedical  year  in  a  medical  col- 
lege, it  must  be  up  to  the  standards  set  by  approved 
colleges.  It  is  advised  that  a  year  in  a  college  of 
dentistry  or  pharmacy  shall  not  be  considered  as  equiv- 
alent to  a  year's  work  in  a  standard  college,  and  that  no 
credit  shall  be  given  for  a  course  in  which  a  student's 
record  for  attendance  for  the  full  year  is  below  80  per 
cent.,  but  that  graduates  of  regular  colleges  who  have 
not  done  the  work  in  these  prescribed  subjects,  may  be 
permitted  to  have  until  the  opening  of  the  second  year 
in  the  medical  college  for  removing  their  conditions. 


54  Medicine  as  a  Professioit. 

The  standards  of  the  American  Medical  Association 
prescribe  that  a  medical  college  must  have  at  least  six 
professors,  giving  their  entire  time  to  medical  work, 
and  an  executive  officer  who  has  sufficient  authority  to 
carry  out  fair  ideals  of  medical  education ;  that  it  has  a 
standard  of  admission  for  students  equivalent  to  those 
given  in  this  chapter;  that  it  offers  a  full  four-years' 
course  of  instruction  of  thirty-two  weeks  each,  and  that 
it  requires  of  the  student  at  least  thirty  hours  of  work 
per  week. 

It  is  also  prescribed  that  the  printed  course  of  study 
should  be  carefully  followed  and  should  include  two 
years  of  laboratory  work  under  the  direction  of  ex- 
perienced teachers  who  are  graduates  of  reputable  med- 
ical schools  in  properly  and  fully  equipped  laboratories 
in  anatomy,  histology,  embryology,  physiology,  chem- 
istry, bacteriology,  pathology,  pharmacology,  thera- 
peutics and  clinical  diagnosis ;  that  there  should  be  two 
years  of  clinical  work  in  hospitals  and  dispensaries  with 
courses  in  internal  medicine,  surgery,  obstetrics,  gyne- 
cology, laryngology,  rhinology,  ophthalmology,  otology, 
dermatology,  hygiene  and  medical  Jurisprudence. 

It  is  well  for  those  who  are  selecting  a  medical  col- 
lege to  study  carefully  the  catalogues  of  the  colleges 
which  they  are  considering  to  see  whether  the  college  is 
able  to  offer  them  the  facilities  which  this  committee 
considers  essential. 

A  college  should  own  and  control  a  hospital  in  which 
the  students  may  come  into  contact  with  patients  under 
the  supervision  of  their  teachers,  and  such  a  hospital  in 
colleges  having  a  hundred  students  should  have  not  less 
than  two  hundred  patients  a  day;  and  there  should  be 
ample  accommodations  for  treating  children's  diseases, 


The  Medical  Colleges.  55 

contagious  diseases  and  nervous  and  mental  disorders, 
and  for  handling  maternity  cases,  and  at  least  thirty 
autopsies  a  year,  together  with  facilities  for  handling 
out-patients. 

It  is  also  recommended  that  an  acceptable  college 
should  have  a  fully  equipped  library,  in  properly  fur- 
nished quarters,  with  a  librarian  in  charge,  and  have  a 
working  museum  with  models  and  specimens  duly 
classified  and  labelled;  that  there  should  be  an  ample 
supply  of  dissecting  material  and  an  experimental  labo- 
ratory with  a  supply  of  live  animals  and  adequate  facili- 
ties for  housing  these  animals. 

As  one  reads  over  these  specifications  and  notes  that 
mention  is  made  of  the  importance  of  having  in  a  med- 
ical school  X-ray  -apparatus,  stethoscopes,  projecto- 
scopes  and  supplies  of  anatomical  charts  and  manikins, 
he  is  forced  to  the  assumption  that  at  the  time  of  mak- 
ing this  report  there  must  have  been  institutions  lack- 
ing in  these  essentials.  This  is  not  surprising  when  one 
considers  that  many  medical  colleges  have  been  organ- 
ized by  practitioners  who  hoped  that  by  teaching  they 
could  add  somewhat  to  the  incomes  which  they  were 
getting  as  practitioners.  One  would  expect  to  find  in 
this  report  recommendations  that  a  medical  college 
should  have  a  certain  minimum  number  of  heads  of  de- 
partments whose  salaries  are  large  enough  to  permit 
them  to  give  all  their  time  to  teaching  and  investiga- 
tion; and  that  for  professional  training  in  a  field  which 
has  such  an  extensive  literature  as  medicine,  it  should 
be  accepted  without  mention  that  a  school  should  not 
only  have  a  complete  library  in  charge  of  a  trained 
librarian  and  that  mention  should  be  made  of  courses 
of  special  training  in  the  use  of  these  libraries. 
5 


56  Medicine  as  a  Profession. 

For  the  guidance  of  the  prospective  student,  the 
American  Medical  Association  publishes  annually  classi- 
fied lists  of  medical  colleges  in  which  these  institutions 
are  rated  according  to  the  standing  of  their  faculty  mem- 
bers, their  teaching  and  administrative  organizations 
and  the  extent  and  character  of  their  equipment  and 
facilities  for  practical  work.  These  lists  should  be  con- 
sulted in  selecting  a  college. 

Success  in  the  acquisition  of  knowledge  and  in  its 
organization  in  the  minds  of  the  students  for  practical 
work  presupposes  that  the  student  knows  something 
about  the  nature  of  the  mind  and  of  the  thinking  and 
learning  processes,  and  although  professional  courses  do 
not  usually  prescribe  anything  nor  do  professional 
schools  generally  recommend  it,  it  will  increase  the  prac- 
tical value  of  what  the  attendant  gets  out  of  any  courses 
if  he  first  reads  or  studies,  with  some  care,  some  of  the 
accessible  books  bearing  upon  the  laws  of  mental  opera- 
tions and  the  principles  of  the  efficient  life.  A  list  of 
these  books  is  given  at  the  end  of  this  chapter. 

Beferences. 

Bennet,  E.  A.     The  Human  Machine.     Doran,  1910.     $.75. 
Colvin,  S.  S.     The  Learning  Process.     Maemillan,  1915. 
Gulick,  L.  H.     The  Efficient  Life.     Doubleday,  1907.     $1.20. 
Locke,  John.     An  Essay  on  the  Human  Understanding. 
Meumann,     E.     The     Psychology     of     Learning.     Appleton, 
1913.     $2.00. 


CHAPTEE  IX. 

A  Geneeal  Sukvey  of  the  Field. 

It  has  been  shown  that  we  have  in  the  entire  country 
about  one  physician  to  every  six  hundred  and  fifty  of 
the  population;  in  country  districts,  one  to  about  every 
two  thousand  people.  Many  of  these  physicians  are  old 
and  have  practically  retired ;  some  are  giving  their  time 
chiefly  to  business;  others,  again,  are  devoting  their 
time  to  public  service;  and  many  are  engaged  in  re- 
search work. 

The  same  motives  which  lead  persons  of  other  trades 
and  professions  to  crowd  into  cities,  lead  medical  men 
to  locate  in  the  great  centers  of  population.  The  phy- 
sician must  go  where  the  people  are.  Moreover,  there 
are  opportunities  in  the  cities  which  are  not  found  in 
the  country  districts ;  there  are  chances  for  hospital  and 
dispensary  work;  the  better  educational  and  social  ad- 
vantages; the  privileges  of  meeting  specialists  in  the 
professional  organizations;  better  fees;  and  opportuni- 
ties for  part-time  salaried  work. 

The  practitioner  in  the  rural  communities,  on  the 
other  hand,  does  not  lose  his  identity,  as  too  often  does 
his  brother  in  the  crowded  cities ;  he  is  generally  one  of 
the  influential  members  of  his  community;  he  com- 
mands a  more  permanent  clientele  and  has  less  competi- 
tion. He  becomes  by  force  of  necessity  more  self-re- 
liant, and  although  his  fees  are  smaller  his  percentage 
of  collections  is  larger. 

57 


58  Medicine  as  a  Peofession. 

The  first  puzzling  problem  of  the  physician  who 
would  devote  his  time  to  private  practice  is  the  selection 
of  a  location.  Those  who  follow  other  trades  and  pro- 
fessions may  sometimes  change  their  locations  to  ad- 
vantage; but  the  fate  of  the  physician  depends  in  a 
great  measure  upon  the  prosperity  of  the  community 
with  which  he  first  casts  his  lot^  for  it  is  rarely  possible 
for  him  to  make  a  change  of  location  without  risking 
considerable  loss. 

The  student  of  this  problem  would  suppose  that  the 
distribution  of  the  three  thousand  or  more  annual  grad- 
uates of  our  medical  schools  who  expect  to  enter  private 
practice  would  be  regulated  according  to  some  well  es- 
tablished principles.  Inquiry  was  made  to  learn  what 
instruction  was  given  by  the  medical  colleges  to  aid  their 
students  in  this  important  matter  of  choosing  a  loca- 
tion. It  seems  that  the  colleges  as  a  rule  overlook  this 
matter  of  giving  instruction  in  regard  to  the  best  meth- 
ods of  marketing  the  capacities  for  service  which  their 
students  developed  through  the  long  and  expensive  years 
of  study.  A  careful  reading  of  some  three  hundred 
answers  to  a  thousand  letters  of  inquiry  seemed  to  indi- 
cate that  the  matter  of  selecting  a  location  has  hereto- 
fore been  largely  a  matter  of  accident  and  chance  and 
that  the  method  of  trial  and  error  resulted  in  the  aggre- 
gate in  a  very  large  amount  of  waste. 

One  man  replied  that  the  final  choice  between 
several  localities  which  he  had  under  consideration  was 
determined  by  a  study  of  the  directories  of  practicing 
physicians  in  those  places.  In  one  city  he  noted  that 
half  of  the  names  which  appeared  in  the  directory  for 
1900  were  not  in  the  list  for  1910.  He  concluded  that 
because  an  unusually  large  number  of  those  who  tried 


A  General  Survey  of  the  Field.  59 

practice  in  that  city  abandoned  it  for  some  reason  or 
other,  the  place  was  to  be  avoided.  Another  replied 
that  while  debating  with  himself  about  the  relative 
advantages  of  two  places  he  consulted  a  banker  friend 
who  pointed  out  to  him  that  the  figures  of  the  state 
banking  department  showed  that  the  average  per  capita 
deposits  in  the  saving  banks  by  the  people  of  one  of  the 
cities  was  much  larger  than  in  the  other  and  that  there- 
fore it  was  safe  to  infer  that  the  first  city  was  more 
prosperous.  Another  reported  that  he  was  deterred 
from  locating  in  a  manufacturing  city  when  a  friend 
showed  him  a  copy  of  the  census  bulletin  which  indi- 
cated that  the  average  annual  earnings  of  factory  work- 
ers who  formed  a  very  large  proportion  of  those  gain- 
fully employed,  was  relatively  small.  Another  investi- 
gated a  new  industrial  city  which  seemed  to  be  under- 
supplied  with  physicians  to  turn  away  from  it  because 
a  very  large  proportion  of  the  inhabitants  were  foreign- 
ers from  a  country  in  which  the  laboring  classes  had 
never  been  educated  to  make  any  considerable  outlays 
for  medical  services  and  because  as  a  rule  these  people 
were  clannish  and  suspicious  of  those  who  did  not  speak 
their  own  language.  One  man  reported  that  by  acci- 
dent a  copy  of  the  atlas  of  the  U.  S.  census  had  fallen 
into  his  hands  and  that  in  looking  over  a  map  showing 
the  relative  value  of  farm  lands  for  the  entire  country 
the  thought  came  to  him  that  a  moderate  sized  town  in 
a  good  farming  country  in  which  a  large  proportion  of 
the  people  were  retired  or  living  on  their  investments 
and  in  which  those  who  were  gainfully  employed  were 
engaged  chiefly  in  commercial  pursuits  would  be  a  good 
place  in  which  to  find  a  permanent  location,  he  added, 
however,  that  "in  such  places  collections  are  confined 


60  Medicine  as  a  Profession. 

almost  entirely  to  the  time  of  the  annual  pa}Tnent  of 
rents  and  the  settlement  days  which  follow  the  sale  of 
crops." 

Not  a  few  sharpers  seem  to  be  lying  in  wait  for  those 
who  are  looking  for  a  location.  A  favorite  dodge  of 
real  estate  promoters  in  boom  towns  is  to  advertise  de- 
sirable openings  for  physicians  when  they  mean  that 
they  have  offices  to  rent  to  desirable  tenants.  There  are 
also  rumors  that  there  have  been  physicians  who  built 
up  records  of  crowded  consultation  rooms  in  order  to 
sell  to  advantage  their  practice  and  office  equipments. 

Sooner  or  later  the  insistent  students  of  the  medical 
colleges  will  demand  that  the  faculties  undertake  an 
investigation  sufficiently  extensive  to  enable  them  to 
work  out  the  sound  underlying  principles  with  which  to 
make  the  approach  to  this  problem  and  that  instruc- 
tion in  these  matters  will  form  a  part  of  the  regular 
work  of  the  colleges. 

It  must  also  follow  sooner  or  later  that  all  medical 
schools  will  follow  the  example  of  other  professional 
schools  and  the  more  progressive  colleges  and  universi- 
ties and  open  for  their  graduates  appointment  offices 
and  bureaus  of  counsel  and  advice  through  which  trained 
and  experienced  men  will  make  available  for  the  use  of 
graduates  well  indexed  and  up-to-date  information  for 
their  guidance  so  as  to  minimize  the  waste  of  time  and 
energy  and  discouragement  which  is  incident  to  the  slack 
period  between  graduation  and  full  employment  as  a 
partial  compensation  for  the  lengthening  of  the  period 
of  medical  study  and  preparation,  nor  is  it  too  much  to 
expect  that  before  long  the  medical  societies  will  awaken 
to  the  fact  that  it  will  be  to  the  interests  of  their  mem- 


A  General  Survey  of  the  Field.  61 

bers  to  aid  in  a  more  rational  distribution  of  the  newly 
graduated  doctors. 

There  are  many  persons  who  prefer  the  routine  work 
of  the  salaried  man  in  institutions.  Appointments  of 
this  kind  are  generally  to  be  had  by  the  young  medical 
graduate ;  but  the  fact  that  after  a  few  years  those  who 
accept  salaried  appointments  leave  them  to  enter  private 
practice,  may  be  taken  as  evidence  that  the  latter  offers 
the  more  durable  satisfactions.  It  is  well,  however,  to 
look  over  the  ever-widening  field  of  salaried  positions. 

The  Field. 

I.  In  private  practice,  city  or  country. 
II.  In  the  service  of  the  National  Government : 
The  army  service. 
The  naval  service. 

The  marine  hospital  and  public  health  service. 
The  pension  department. 
The  Indian  service. 
The  Philippine  service. 
The  Canal  Zone  and  coast  survey. 
The  pure  food  division  of  the  department  of 

agriculture. 
III.  In  state  and  municipal  service: 
Public  health  department. 
In  departments  of  food  and  drug  inspection. 
In  departments  of  vital  statistics. 
In  sanitary  work. 
As   milk   inspectors   and   bacteriologists   and 

chemists. 
As  lecturers  on  health  topics. 
In  public  hospital  service. 


62  Medicine  as  a  PROFESsioisr. 

In  penal  institutions. 

In  charitable  institutions. 

With  the  state  militia. 

As  medical  school  inspectors. 

As  supervisors  of  physical  training  in  schools. 
IV.  In  county  service: 

As  health  officers.    ■ 

Pension  examining  surgeons. 

Physicians  to  the  poor. 

Coroners. 
V.  In  service  of  corporations. 
VI.  In  research  work. 
VII.  In  service  of  fraternal  societies. 

Some  of  these  newer  fields  of  work  are  rapidly  being 
extended.  Corporations  which  employ  many  men  or 
are  engaged  in  hazardous  undertakings  employ  phy- 
sicians and  surgeons  to  administer  to  the  injured  as 
promptly  as  possible  in  order  to  minimize  the  sufferings 
of  their  employees;  to  keep  down  the  cost  of  maintain- 
ing the  sick  and  the  disabled  and  to  lessen  their  own 
liabilities  for  damages.  The  railroad  and  traction  com- 
panies have  surgeons  at  convenient  points  along  their 
lines,  and  insurance  companies  have  physicians  in  all 
communities  in  which  they  do  business.  Every  large 
steamship  has  a  physician  on  its  staff  of  regular  officers. 
Fraternal  societies  employ  physicians  by  the  year  to 
wait  upon  their  members,  who  pay  annual  dues  for  this 
service  whether  they  are  sick  or  well.  Large  hotels 
have  regular  house  physicians  for  their  guests,  and 
many  of  the  wealthy  families  employ  physicians  by  the 
year  to  travel  with  them  wherever  they  go. 

Private  sanitariums  employ  large  numbers  of  young 
medical  graduates,  and  many  experienced  physiciaiiS 


A  Genekal  Survey  of  the  Field.  63 

conduct  health-building  institutions  as  business  enter- 
prises. Organizations  engaged  in  movements  for  pro- 
moting the  public  welfare  employ  medical  men  to  pre- 
sent their  several  causes  to  the  public,  the  field  of  med- 
ical journalism  takes  up  the  time  of  others,  and  lately 
enterprising  publishers  of  daily  papers  have  begun  to 
employ  physicians  to  conduct  departments  on  personal 
efficiency. 


CHAPTEE  X. 

The  Army  Service. 

The  medical  service  of  the  army  is  divided  into  five 
corps:  medical  corps,  the  medical  reserve  corps,  the 
dental  corps,  the  hospital  corps  and  the  nurse  corps. 

The  medical  corps  consists  of  a  surgeon  general,  with 
the  rank  of  a  brigadier  general,  14  colonels,  24  lieuten- 
ants with  the  rank,  pay  and  allowances  of  officers  of 
grades  corresponding  to  those  in  the  cavalry  service. 
No  person  shall  be  appointed  to  this  service  until  ex- 
amined and  approved  by  an  army  medical  board. 

The  appointments  are  made  to  the  junior  grade,  or 
grade  of  first  lieutenant ;  and  after  three  years  of  service 
as  lieutenant,  one  becomes  eligible  for  examination  for 
promotion,  to  the  grade  of  captain.  All  further  pro- 
motion to  higher  grades  is  by  seniority,  although  the  ap- 
plicant is  subjected  to  examination  to  determine  fitness 
for  advancement. 

A  first  lieutenant  receives  $2,000  per  annum,  or 
$166.66  monthly.  At  the  end  of  three  years  he  is  pro- 
moted to  a  captaincy  and  receives  $2,400  a  year.  In 
two  years  more  he  receives  an  increase  of  ten  per  cent., 
making  $2,640  or  $220  per  month.  After  10  years' 
service  the  pay  would  be  $2,880  annually,  or  $240  per 
month. 

The  pay  attached  to  the  rank  of  major  is  $3,000  a 
year,  which,  with  10  per  cent,  added  for  each  five  years' 
service,  becomes  $3,600  after  10  years,  $3,900  after  15 

64 


The  Akmy  Service.  65 

years  and  $4,000  after  20  years.  The  monthly  pay  of 
lieutenant-colonel,  colonel,  and  brigadier-general  is  $375, 
$416.66  and  $500  respectively.  Officers,  in  addition  to 
their  pay  proper,  are  furnished  with  a  liberal  allowance 
of  quarters  according  to  rank,  either  in  kind,  or,  where 
no  suitable  government  building  is  available,  by  com- 
mutation; fuel  and  light  are  also  provided.  When 
travelling  on  duty  an  officer  receives  mileage  for  the 
distance  travelled,  including  the  distance  covered  in 
joining  his  first  station  after  appointment  as  first  lieu- 
tenant; the  amount  allowed  is  usually  sufficient  to  cover 
all  expenses  of  journey.  On  change  of  assignment  he 
is  entitled  to  cost  of  transportation  of  professional  books 
and  papers  and  a  reasonable  amount  of  baggage. 
Mounted  officers,  including  all  officers  of  the  medical 
corps,  are  provided  with  forage,  stabling  and  transpor- 
tation for  horses  owned  and  usually  kept  by  them,  not 
exceeding  two  for  all  ranks  below  that  of  brigadier. 
Horses  and  horse  equipments  are  furnished  by  the  gov- 
ernment for  all  mounted  officers  below  the  grade  of 
major.  Groceries  and  other  articles  may  be  purchased 
from  the  post  commissary  at  about  wholesale  prices. 
Instruments  and  appliances  are  liberally  supplied  for 
the  use  of  medical  officers.  Well-selected  professional 
libraries  are  supplied  to  each  hospital,  and  standard 
modern  publications  on  medical  and  surgical  subjects 
are  added  from  time  to  time ;  current  issues  of  a  number 
of  representative  medical  journals  are  also  furnished  for 
their  use.  At  each  military  post  there  is  also  a  labora- 
tory for  those  interested  in  such  work ;  and  medical  offi- 
cers are  encouraged  to  carry  on  special  lines  of  profes- 
sional study  which  appeal  to  them. 

The  Army  medical  officers   are  given  one  month's 


66  Medicine  as  a  Profession. 

leave  of  absence  at  full  pay  each  year;  and  if  this  priv- 
ilege is  not  accepted  each  year,  it  is  allowed  to  accumu- 
late for  four  years,  and  the  four  months  may  be  taken 
in  a  continuous  leave.  The  medical  officer  may  also 
have  leave  of  absence  by  permission  beyond  this  one 
month,  upon  half  pay.  All  leaves  of  absence  granted  on 
account  of  sickness  are  with  full  pay. 

Medical  officers  may  be  retired  at  the  expiration  of 
forty  years'  service,  or  at  any  time  on  account  of  dis- 
ability incurred  in  the  line  of  duty.  The  pay  of  retired 
officers  is  three  fourths  the  amount  of  the  full  pay  of 
their  rank  upon  retiring.  Officers  have  also  the  privi- 
lege of  attending  the  Army  Medical  School,  wherever 
practical. 

This  school  is  established  especially  for  the  training 
of  the  younger  men  in  military  surgery,  including  the 
transportation  of  the  wounded,  first-aid  treatment, 
operative  surgery,  military  sanitation,  including  instruc- 
tion in  the  examination  of  air,  water,  food,  clothing, 
the  location  and  sanitation  of  camps,  etc.,  military  med- 
icine and  clinical  and  sanitary  microscopy. 

The  officers  are  detailed  from  time  to  time  to  service 
at  stations,  near  the  principal  medical  centers  of  the 
United  States,  in  order  to  give  them  opportunities  to 
attend  lectures,  clinics,  and  visit  hospitals,  attend  meet- 
ings of  medical  societies,  etc.,  so  that  they  may  keep  in 
touch  with  the  most  advanced  ideas  of  the  time. 

Applicants  for  first  appointment  must  be  between  the 
ages  of  22  and  30  at  the  time  of  taking  the  examination, 
citizens  of  the  United  States,  and  graduates  of  reputable 
medical  schools. 

The  candidates  must  have  had  hospital  or  some  prac- 
tical experience  in  the  practice  of  medicine.     Interne 


The  Army  Service. 


67 


service  in  some  hospital  for  a  year  or  for  a  year  and  a 
half  is  the  best  and  most  acceptable  way  to  gain  the  ex- 
perience. For  admission  to  the  army  medical  corps  this 
is  obligatory. 

Besides  the  examination  to  test  intellectual  fitness  for 
the  service,  the  candidate  must  possess  certain  physical 
requirements. 

The  physical  examination  must  be  thorough.  Candi- 
dates who  fall  below  64  inches  in  height  will  be  rejected. 
Each  candidate  is  also  required  to  certify  that  he  labors 
under  no  physical  infirmity  or  disability  which  would 
interfere  with  the  efficient  discharge  of  any  duty  which 
may  be  required.  Errors  of  refraction,  if  vision  is  not 
below  20/100  in  either  eye,  are  not  cause  for  rejection, 
provided  they  are  not  accompanied  by  ocular  disease 
and  are  entirely  corrected  by  appropriate  glasses. 

The  appended  table  is  given  for  convenience  of  refer- 
ence, and  it  is  expected  that  the  candidate  approxi- 
mates to  these  measurements. 

The  army  medical  service  offers  to  staff  physicians 


Physical  Proportions  for  Height,  Weight  and  Chest 

Measurement. 


Height, 
Inches. 

Weight, 
Pounds. 

Chest  Measurement. 

At  Expiration, 

Mobility. 

Inches. 

Inches. 

64 

128 

32 

2 

65 

130 

32 

2 

66 

132 

32^ 

2 

67 

134 

33 

2 

68 

141 

33| 

2J 

69 

148 

33^ 

n 

70 

155 

34 

2J 

71 

162 

34.1 

2J 

72 

169 

34^ 

3 

73 

176 

351 

3 

68  Medicine  as  a  Peofession. 

and  their  families  many  social  advantages.  The  social 
standings  of  the  members  of  the  staffs  and  their  fam- 
ilies, whether  in  camp  or  in  field,  are  determined  by 
seniority.  It  is  true  that  associations  are  necessarily 
somewhat  restricted,  and  that  in  some  places  a  good 
deal  of  snobbery  permeates  the  atmosphere. 

Post  duty  becomes  more  or  less  of  a  routine  character 
which  is  not  always  favorable  to  the  development  of  the 
physician;  and  since  the  post  physician  has  no  compe- 
tition, and  his  patients  have  little  encouragement  to 
appeal  from  his  treatment,  there  is  little  to  stimulate 
him  to  extend  his  equipment.  In  times  of  active  war- 
fare, and  on  the  field  of  battle  he  has  every  chance  to 
develop  his  resourcefulness. 

The  Army  Medical  Museum  and  Library  in  the  Sur- 
geon-General's office  contains  an  interesting  collection  of 
anatomical  specimens,  and  nearly  200,000  volumes  of 
medical  and  surgical  literature.  This  is  the  largest  mod- 
ern medical  library  in  the  world.  The  museum  was  pri- 
marily intended  for  the  medical  officers  of  the  army.  It 
was  started  after  the  Civil  War  and  was  designed  to  show 
the  effects  of  gun-shot  wounds  and  their  treatment,  in 
order  to  enable  the  surgeons  of  the  army  to  be  better 
prepared  for  such  work  in  the  future  emergencies. 
Both  the  museum  and  the  library  are  being  continuously 
enriched  by  the  contribution  of  specimens  and  books 
from  physicians  and  surgeons  in  private  practice. 

To  a  young  man  or  woman  contemplating  the  study 
of  medicine,  who  happens  to  be  in  Washington,  a  visit 
to  this  collection,  which  is  open  from  9  a.  m.  to  4  p.  m. 
and  is  free,  is  profitable,  as  it  shows  the  extent  of  the 
field  of  medicine  and  the  progress  which  has  been  made 
in  surgery. 


CHAPTER  XI. 

The  Naval  Service. 

The  routine  of  the  doctor  attached  to  the  naval  train- 
ing stations  is  not  unlike  the  work  at  the  army  post  but 
when  he  joins  the  staff  of  a  battleship  he  gets  a  much 
greater  variety  of  experiences,  especially  when  his  ship 
goes  on  a  long  cruise.  The  senior  medical  officer  of  a 
ship  holds  a  very  responsible  position;  as  health  officer, 
he  becomes  familiar  with  conditions  in  the  seaboard 
towns  of  all  climates ;  as  surgeon,  he  is  called  upon  to  do 
a  great  variety  of  work ;  moreover,  he  is  the  eye  special- 
ist, the  medical  exarainer,  the  food  inspector;  he  is  also 
the  dentist,  and  he  has  to  see  that  the  quarantine  regu- 
lations of  all  countries  where  his  ship  touches  are  ob- 
served. 

As  the  health  officer  of  the  ship,  the  doctor  makes  daily 
inspections  of  cabins,  wash  rooms,  barber  shops,  gal- 
leries, pantries  and  the  general  cleanliness  of  the  men. 
Once  a  week  a  general  inspection  is  made  of  the  entire 
ship.  He  has  supervision  of  the  heating  and  ventila- 
tion of  the  seamen's  quarters,  and  the  water  supplies. 

When  the  ship  casts  anchor,  he  gets  in  touch  with  the 
health  officers  of  the  port,  learns  what  diseases  are  prev- 
alent, and  notifies  the  commanding  officer,  so  that  he 
may  determine  what  privileges  may  be  accorded  to  the 
crew  while  the  ship  remains  in  port. 

He  inspects  the  meats  and  other  foods  which  are 
taken  on  board  ship,  and  plans  the  rations  for  the 

69 


70  Medicine  as  a  Profession-. 

sailors.  He  holds  himself  in  readiness  for  consulta- 
tions every  morning,  prescribes  medicines  and  special 
diets  for  the  sick,  and  directs  special  assignments  for 
those  who  are  not  able  to  attend  to  their  regular  duties, 
or  requests  for  them  relief  when  necessary.  Ordinary 
cases  of  sickness  are  handled  as  in  private  practice,  but 
those  who  are  suffering  from  serious  sickness  or  chronic 
ailments  may  be  transferred  to  hospital  ships  or  to  hos- 
pitals on  land.  This  is  done  in  times  of  peace  as  well 
as  in  war  to  preserve  the  fighting  efficiency  of  the  ship. 

A  modern  war  vessel  is  a  veritable  machine  shop; 
accidents  are  likely  to  occur  at  any  time,  so  that  emer- 
gency service  must  always  be  available  for  treating  broken 
bones,  making  amputations,  treating  injured  eyes  and 
performing  every  kind  of  operation  which  is  required 
of  a  city  hospital  staff. 

As  medical  examiner,  he  passes  upon  the  physical  fit- 
ness of  men  before  they  are  accepted  for  service ;  gunners 
and  signal  men  must  have  their  vision  frequently  ex- 
amined; divers  must  be  examined  before  undertaking 
dangerous  work,  and  the  pugilists  before  entering  box- 
ing bouts. 

These  physicians  must,  therefore,  be  prepared  for 
ministering  to  adult  men  for  a  great  variety  of  ailments, 
but  they  have  an  advantage  over  the  private  practitioner, 
because,  as  a  rule,  they  have  modern  appliances  for  their 
work;  the  hospital  equipment  is  complete,  sick  quarters 
are  well  arranged,  operating  rooms  are  modern,  testing 
appliances  are  adequate  and  usually  the  reference  libra- 
ries are  comprehensive. 

The  service  demands  complete  and  accurate  records 
of  all  disabilities  and  fatalities,  so  that  the  physician  re- 
ceives such  a  training  in  the  systematic  and  orderly 


The  Naval  Service.  71 

transaction  of  the  routine  of  his  office  as  few  other  prac- 
titioners get. 

After  this  brief  review  of  the  work  which  is  assigned 
to  the  medical  officer,  it  is  not  surprising  to  note  the 
high  standing  which  is  accorded  to  him  as  an  officer,  and 
the  recognition  which  is  given  to  him  socially,  and  that 
his  personal  accommodations  on  board  ship  are  as  at- 
tractive as  those  of  the  other  officials. 

It  will  also  be  readily  inferred  that  for  such  positions 
of  great  responsibility  men  of  the  highest  types  are  re- 
quired. To  get  on  smoothly  with  other  officers,  a  man 
should  have  had  the  advantage  of  good  social  training; 
to  win  the  esteem  and  hold  the  respect  of  representatives 
of  all  classes  which  go  to  make  up  the  crew  of  a  ship,- 
the  medical  officer  must  be  a  man  of  integrity  and  cour- 
age ;  as  the  representative  of  his  country  among  the  edu- 
cated men  of  other  lands,  he  should  have  a  broad  gen- 
eral culture ;  and,  moreover,  he  must  be  energetic  enough 
to  dispatch  a  great  amount  of  work. 

There  are  some  disadvantages  with  which  these  men 
must  contend.  Their  assignments  are  frequently 
changed,  they  are  compelled  to  sever  their  home  ties. 
Owing  to  the  routine  nature  of  much  of  their  work,  they 
are  not  likely  to  develop  those  rare  traits  which  make  of 
older  family  physicians  the  guides,  counsellors  and 
friends  of  the  families  of  their  patients. 

The  requirements  for  admission  to  the  service  are 
given  somewhat  in  detail,  because  they  comprehend 
what  -the  best  experts  consider  the  physical  basis  of 
efficiency. 

For  appointment  in  the  medical  corps  of  the  navy, 
the  candidate  must  be  a  citizen  of  the  United  States, 
and  between  21  and  30  years  of  age.  He  must  be  a 
6 


72  Medicine  as  a  Profession". 

graduate  of  a  reputable  school  of  medicine.  He  must 
apply  for  permission  to  appear  before  the  Board  of 
Medical  Examiners.  The  application  must  be  in  the 
handwriting  of  the  applicant,  and  must  be  accompanied 
by  the  following :  letters  or  certificates  from  two  or  more 
persons  of  repute,  testifying  from  personal  knowledge 
to  his  good  habits  and  moral  character;  a  certificate  of 
citizenship ;  certificates  of  graduation  from  colleges  and 
medical  schools. 

Form  of  Application. 

191 

Sir:  I  request  permission  to  be  examined  for  an  ap- 
pointment as  assistant  surgeon  in  the  Medical  Eeserve 
Corps,  with  a  view  to  subsequent  examination  and  ap- 
pointment in  the  Medical  Corps  of  the  United  States 
Navy. 

I  was  born  at ,  and  was 

years  of  age  on  the day  of 

191. .,  and  am  a  citizen  of  the  United  States,  residing 

in ,  county  of ,  in 

the  State  of ,  and  graduated 

from Medical   School  in  191 . . 

I  forward  herewith  certificates  of  moral  character, 
habits  and  citizenship. 

Very  respectfully. 


Chief  of  the  Bureau  of  Navigation, 

Navy  Department,  Washington,  D.  C. 
Via  the  Surgeon-General,  U.  S.  Navy. 

The  physical  qualifications  of  applicants  for  appoint- 
ment as  officers  in  the  medical  corps  are  decided  upon 
by  an  examining  board  consisting  of  medical  officers  of 


The  Naval  Service.  73 

the  navy.  The  physical  examination  of  candidates  will 
precede  the  mental  and  professional.  No  one  found 
physically  disqualified  will  be  examined  further.  No 
material  physical  defects  will  he  waived  in  any  case  for 
any  reason. 

A  candidate  must  declare  under  oath  that  he  labors 
under  no  mental  or  constitutional  disease  or  weakness, 
nor  under  any  other  imperfection  or  disability  which 
might  interfere  with  the  most  efficient  discharge  of  the 
duties  of  an  officer  in  any  climate. 

Table  of  physical  proportions  for  height,  weight  and 
chest  measurement: 

Height,  Weight,  Chest  (mean  cir- 

Inches.  Pounds.  cumf erence) ,  Inches 

66 132 33-1/2 

67 134 34 

68 141 34-1/2 

69 148 34-3/4 

70 155 35-1/2 

71 162 36 

72 169 36-1/4 

73 176 36-3/4 

It  is  not  necessary  that  the  applicant  should  conform 
exactly  to  the  figures  in  the  foregoing  table,  which  is 
given  to  show  what  is  regarded  as  a  fair  standard  of 
physical  proportions.  A  variation  not  exceeding  15 
pounds,  not  to  fall  below  132  pounds  in  weight  or  1 
inch  in  the  mean  chest  measurement,  below  the  standard 
given  in  the  table,  is  admissible  when  the  candidate  for 
appointment  is  active,  has  firm  muscles,  and  is  evi- 
dently vigorous  and  healthy.  A  chest  expansion  of  less 
than  2 J  inches  is  a  sufficient  cause  for  the  rejection  of 
the  applicant. 


74  Medicine  as  a  Profession". 

Any  one  of  the  following  conditions  will  be  sufficient 
to  cause  rejection:  Feeble  constitution;  poor  physique; 
impaired  general  health;  any  disease  or  deformity, 
either  congenital  or  acquired,  which  would  impair  effi- 
ciency, such  as  weak  or  deranged  intellect,  cutaneous 
diseases,  parasites  of  the  skin  or  its  appendages,  de- 
formity of  the  skull,  abnormal  curvature  of  the  spine, 
torticollis,  inefficiency  of  joints  or  limbs,  deformity  of 
joints  or  bones  either  congenital  or  the  result  of  disease 
or  injury,  epilepsy,  or  other  convulsions,  disease  of  the 
eye,  defective  vision,  color-blindness,  impaired  hearing 
or  disease  of  the  ear,  chronic  nasal  catarrh,  ozena,  polypi, 
great  enlargement  of  the  tonsils,  impediment  of  speech, 
disease  of  heart  or  lungs,  enlarged  abdominal  organs, 
evidence  of  sclerosis,  tumors,  hernia,  large  varicocele, 
sarocele,  hydrocele,  stricture,  fistula,  hemorrhoids,  vari- 
cose veins,  disease  of  the  genito-urinary  organs,  de- 
formed or  diseased  feet;  evidences  of  intemperance  or 
of  the  morbid  use  of  drugs,  loss  of  many  teeth,  or  teeth 
generally  unsound  (teeth  properly  filled  not  to  be  con- 
sidered unsound).  Every  applicant  must  have  at  least 
20  sound  teeth,  and  of  these  not  less  than  4  opposed  in- 
cisors and  4  opposed  molars. 

Acuteness  of  vision  must  be  as  follows :  For  the  med- 
ical corps,  not  less  than  12/20  for  each  eye,  unaided  by 
glasses,  and  capable  of  correction  by  glasses  to  20/20. 

Upon  entering  the  service,  a  medical  officer  is  assigned 
to  one  of  the  naval  hospitals  until  the  following  October, 
when  the  Naval  Medical  School,  at  Washington,  opens. 
He  is  then  transferred  to  this  school  for  six  months  of 
study.  One  might  wonder  why  this  is  necessary,  when 
none  but  graduates  from  reliable  medical  colleges  are 
accepted.     No  medical  college  can  train  physicians  suffi- 


The  ISTaval  Service.  75 

ciently  in  the  rules,  regulations,  discipline,  customs, 
uniforms  and  other  matters  of  detail  of  the  service. 
The  young  officer  receives  pay  while  attending  this 
Naval  Medical  College,  after  which  he  is  assigned  to 
sea  duty  for  3  years  as  an  assistant  surgeon,  and  after 
that  he  is  promoted  to  the  rank  of  passed  assistant, 
which  carries  with  it  more  salary  and  more  responsi- 
bility. 

The  promotion  to  the  grades  of  surgeon,  medical  in- 
spector, and  medical  director  is  governed  by  seniority, 
as  the  vacancies  in  higher  ranks  occur. 

A  medical  officer  has  the  privilege  of  retiring  after 
thirty  years'  service,  receiving  three  fourths  of  the 
highest  salary  of  the  grade  in  which  he  served  when 
retired. 

Personnel  of  Medical  Service  of  U.  S.  Navy. 

Allowance  for 
Pay.  Quarters. 

11  Surgeon-generals $6,000  $1,152 

,    17  Medical  directors 5,000  1,008 

14  Medical  inspectors 4,500  864 

81  Surgeons 3,300-4,000  720 

158  Passed  assistants   2,400-3,120  576 

49  Assistant  surgeons 2,000  432 

Naval  Hospitals  are  located  as  follows:  Annapolis, 
Md. ;  Aucon,  Panama;  Canacao,  P.  I.;  Chelsea,  Mass.; 
Colon,  Panama;  Great  Lakes,  South  Chicago;  Guam, 
Miarian  Island;  Las  Animas,  Cal. ;  Mare  Island,  Cal. ; 
Narragansett  Bay,  E.  L;  Norfolk,  Va. ;  Pearl  Harbor, 
Hawaii;  Pensacola,  Fla. ;  Philadelphia;  Port  Eoyal,  S. 
C;  Portsmouth,  N.  H. ;  Puget  Sound,  Wash.;  San 
Juan,  Porto  Eico;  Sitka,  Alaska;  H.  S.  S.  Eelief ;  H.  S. 
S.  Solace;  Washington,  D.  C;  Yokohama,  Japan. 


76  Medicine  as  a  Profession. 

The  Hospital  Ship. 

The  hospital  ships  today  are  nothing  less  than  float- 
ing hospitals.  The  divisions  are  similar  to  the  hospitals 
on  land;  medical  wards  for  the  sick,  other  departments 
for  the  surgical  cases,  and  isolation  wards  for  the  infec- 
tious diseases.  There  are  also  special  rooms  for  the 
eye,  ear,  nose  and  throat  cases,  the  dispensary  for  the 
sick  who  are  not  confined  to  bed,  the  officers'  sick  quar- 
ters, the  dental  room,  the  pharmacy.  X-ray  room,  chem- 
ical and  bacteriological  laboratories  and  operating  rooms. 

Each  of  the  hospital  ships  has  its  commanding  officer 
and  crew  for  navigation,  while  the  hospital  is  in  charge 
of  an  executive  medical  officer  who  is  responsible  for 
the  management  of  the  hospital.  The  medical  staff 
usually  consists  of  six  or  more  medical  officers,  a  dentist 
and  a  pharmacist. 

The  executive  surgeon  is  supreme  in  the  medical 
service,  and  under  his  supervision  some  of  the  most 
perfect  team  work  is  developed.  Every  medical  officer 
is  assigned  to  a  definite  duty.  He  is  required  to  make 
daily  reports.  Every  evening,  consultations  are  con- 
ducted to  discuss  the  treatment  of  cases,  the  necessity 
of  operation  and  the  methods  to  be  pursued. 

The  routine  is  methodical,  and  is  conducive  to  the 
best  professional  development.  The  reports  must  be  in 
detail,  and  any  neglect  of  duty,  or  incompetency  in 
service  will  show  in  the  reports.  There  is  possibly  no 
field  of  medical  service  that  will  develop  the  resource- 
fulness of  a  young  physician  so  satisfactorily  as  the 
service  on  a  hospital  ship.  The  ships  accompany  the 
war  fleets,  and  the  ill  on  the  war  vessels  are  transferred 
to  the  hospital  ships. 


•       CHAPTER  XII. 

The  Indian  Service. 

The  remnants  of  the  Indian  tribes  scattered  over  the 
western  states  and  territories  are  the  special  care  of  the 
federal  government.  The  physicians  who  minister  to 
their  needs  are  salaried  employees  of  the  government. 
The  field  should  be  attractive  to  young  men,  more  espe- 
cially as  it  affords  experience  on  sanitary  supervision 
and  in  preventative  measures  as  well  as  in  medical  treat- 
ment for  diseases. 

These  men  are  under  the  supervision  of  the  Depart- 
ment of  the  Interior.  The  staff  comprises:  a  medical 
supervisor;  2  assistant  supervisors;  6  eye  specialists;  7 
dentists;  108  physicians;  78  contract  physicians;  3 
traveling  nurses;  68  regular  nurses;  72  field  matrons. 

Entrants  are  selected  by  civil-service  examination. 
Announcements  of  these  examinations  are  made  in  the 
semi-annual  circulars  of  information,  which  may  be 
secured  by  writing  to  the  Civil  Service  Commission  at 
Washington. 

The  annual  report  of  the  commission  states  the  num- 
ber examined,  the  number  passed,  and  the  number  ap- 
pointed each  year.  From  these  reports  it  appears  that 
a  large  percentage  of  those  who  pass  the  examination 
secure  appointments. 

The  entrance  salary  for  medical  men  for  full-time 
service  is  from  $900  to  $1,100  with  certain  expense 
allowance.     Promotions  are  made  as  vacancies  occur. 

77 


78  Medicine  as  a  Profession-. 

The  contract  physician  is  usually  a  physician  who  is 
available  in  sparsely  settled  districts  where  there  is  not 
enough  practice  to  require  the  full  time  of  a  physician. 
These  men  get  about  $480  to  $500  per  year  from  the 
government  for  this  part  time  service. 

These  physicians  are  located  on  Indian  reservations 
where  schools  are  operated.  These  stations  are  the 
headquarters  for  the  reservation  officials,  schools  and 
hospitals.  The  Indians  come  to  the  hospitals  for  treat- 
ment and  in  many  cases  travel  fifty  or  a  hundred  miles. 

In  former  times  the  Indians  depended  upon  their  own 
medicine  men.  Before  the  government  controlled  the 
Indian  tribes,  the  medicine  men  were  few.  As  an  old 
Indian  chief  expressed  it:  "When  the  medicine  man 
examined  a  patient  and  promised  a  cure  and  the  patient 
died,  then  we  killed  the  medicine  man,  but  today  the 
government  does  not  permit  us  to  do  this,  and  so  we 
have  numerous  medicine  men." 

Today  the  medicine  men  are  very  much  in  evidence 
among  some  tribes,  but  not  more  so  than  "pow-wow'^ 
doctors  among  the  ignorant  whites  and  the  negroes. 
One  even  hears  of  these  charm  doctors,  magnetic  healers, 
with  their  various  mutterings  and  incantations,  in  many 
of  the  so-called  educated  white  communities. 

The  Indian  tribes  differ  as  much  in  their  tribal  prac- 
tices and  customs  and  physiognomy,  as  do  the  Germans, 
Italians,  Irish  and  English.  Many  interesting  customs 
prevail,  as  for  instance,  the  disposition  of  the  dead.  The 
Navajo  Indians  burn  the  house  or  tent  in  which  the 
deceased  lived,  together  with  the  body  of  the  dead.  The 
credit  is  given  the  old  Mosaic  Law  for  the  establishment 
of  the  first  sanitary  code,  yet  there  is  found  among  the 
most  uncivilized  Indian  tribes  a  practice  of  cremation 


The  Indian  Service.  79 

of  the  dead,  and  burning  of  the  house  and  all  the  belong- 
ings of  the  dead — a  sanitary  measure  against  the  spread 
of  disease.  Small-pox  epidemics  have  in  many  instances 
nearly  wiped  out  whole  tribes,  and  while  the  Navajo 
Indians  knew  nothing  of  the  bacterial  cause  of  disease, 
they  instituted  this  effective  sanitary  practice  to  prevent 
its  spread. 

The  physicians  of  the  Navajos  Indian  Service  respect 
this  traditional  practice,  and  when  any  Indian  is  fatally 
sick  in  the  government  reservation  hospital,  he  is  moved 
out  of  the  hospital  to  a  tent  or  to  his  home  before  he 
dies.  No  Navajo  would  ever  enter  the  hospital  if  to 
his  knowledge  any  one  had  died  in  it. 

Dr.  N.  F.  Canaday,  who  was  in  the  Indian  Service 
among  the  Pueblo  Indians,  says :  "  The  Pueblo  Indian 
was  slow  to  make  new  friends,  but  after  he  accepted  the 
new  friendship,  he  was  very  loyal.  Some  of  the 
staunchest  friends  I  ever  had  were  Indians.^' 

The  following  incident  given  by  Dr.  Clarence  W.  Mul- 
likin,  formerly  of  the  Indian  Medical  Service,  shows 
how  they  appreciate  the  white  medicine  men.  "While 
stationed  at  Oraibi,  Ariz.,  a  Navajo  Indian  chief  came 
in  one  day  to  consult  me  concerning  the  physical  condi- 
tion of  his  son,  who  was  at  that  time  quite  sick.  The 
chief  told  me  that  the  young  man  was  his  eldest  son, 
and  he  was  very  anxious  that  he  should  live  to  take  his 
father's  place  as  chief  of  his  particular  clan.  He  told 
me  that  he  had  hired  several  of  the  Navajo  Indian  medi- 
cine men  to  treat  his  boy,  and  each  in  his  turn  had 
failed  to  restore  the  boy's  health;  but  for  their  service 
they  had  taken  most  of  his  horses,  cattle  and  sheep ;  and 
now  he  was  a  poor  man,  and  his  son  about  to  die.  The 
sand  painting,  the  Indian  dance,   drinking  of  sacred 


80  Medicine  as  a  Peoeession. 

potions  and  all  of  the  superstitious  methods  of  treat- 
ment known  to  the  Navajo  Indian  medicine  men  had 
failed;  as  a  last  resort  he  had  come  to  the  white  medi- 
cine man  for  help. 

"In  his  own  language  he  told  how  his  boy  was  sud- 
denly taken  sick  with  a  chill  and  vomiting,  and  had 
then  developed  a  high  fever  which  lasted  several  days. 
He  breathed  hard  and  fast,  and  coughed  up  a  bloody 
sputum,  and  had  much  pain  in  his  left  side.  After 
several  days  had  passed  the  fever  disappeared,  but  the 
boy  continued  to  grow  weaker  and  weaker  and  thinner 
and  thinner,  until  now  after  six  weeks  of  sickness  he 
was  so  weak  that  he  could  not  lift  his  arm,  and  had  the 
appearance  of  a  mass  of  bones  with  the  skin  alone  cover- 
ing them.  His  left  side  was  bulging  so  much  that  it 
seemed  as  though  it  would  burst.  It  was  on  a  Saturday 
evening  that  the  chief  came  to  talk  to  me.  I  told  him 
to  go  home  and  I  would  come  the  following  morning  to 
see  what  could  be  done  for  his  sick  boy. 

"  Early  the  next  morning,  after  getting  together  the 
necessary  drugs  and  surgical  supplies  which  I  thought 
I  might  need,  and  in  company  with  a  Mexican  Indian 
trader,  we  began  the  trip  to  the  chief's  camp  in  a  buggy 
with  two  strong  horses  to  pull  us.  We  were  to  go  a  dis- 
tance of  about  fifty  miles.  About  noon  we  reached  the 
camp.  Our  patient  was,  indeed,  a  sad  sight  to  behold. 
He  had  had  pneumonia  and  now  had  a  large  collection 
of  pus  in  his  left  side.  His  heart  was  very  weak  and 
beating  at  the  rate  of  150  beats  per  minute.  I  can  see 
him  now  as  he  lay  there  on  the  warm  desert  sand — a 
mere  heap  of  skin  and  bones,  struggling  for  his  breath, 
each  gasp  seemed  to  be  his  last.  Death  apparently  was 
only  a  few  hours  distant. 


The  Indian  Service.  81 

"I  explained  to  the  chief  that  there  was  practically 
no  hope  for  the  boy  and  in  order  to  help  him  at  all,  there 
would  have  to  be  some  openings  made  in  his  side  so  that 
the  pns  could  drain  out.  His  heart  was  too  weak  for  an 
anesthetic  to  be  given  to  relieve  pain.  This  was  ex- 
plained to  the  boy  and  he  said  he  would  be  glad  to  have 
the  opening  made  in  his  side  and  was  willing  to  suffer 
the  pain,  even  if  it  only  helped  him  to  die  easier;  and 
then,  too,  he  wished  so  much  to  live,  and  if  this  was  a 
chance  for  recovery,  he  wanted  to  take  it.  These  open- 
ings were  made  in  his  side  and  most  of  the  pus  drained 
out.  The  side  was  irrigated  with  a  solution  consisting  of  a 
small  amount  of  carbolic  acid  in  boiled  water,  which  I  had 
brought  with  me.  Tubes  were  placed  in  the  openings 
to  allow  further  drainage.  The  young  man  suffered 
much  pain  but  stood  it  bravely.  I  stayed  with  him 
three  hours  and  by  the  time  I  left  he  felt  much  relieved 
and  breathed  easier. 

"Before  leaving  I  gave  the  chief  some  medicine  for 
his  son  and  explained  how  the  patient  should  be  cared 
for.  He  was  also  advised  to  let  me  know  if  his  son  was 
still  alive  on  the  next  Saturday;  if  so,  I  would  return 
again.  On  the  appointed  day  I  received  word  that  our 
patient  was  alive  and  better.  The  next  day  I  returned 
to  the  chief's  camp  and  found  the  boy  much  improved. 
I  again  left  medicine  for  him  and  gave  instructions  as 
to  how  to  care  for  him.  Once  after  this  second  visit  I 
heard  that  the  boy  continued  to  grow  stronger. 

"  Several  weeks  later  I  left  my  station  at  Oraibi  and 
moved  to  the  hospital  at  Tuba,  Arizona,  which  was  more 
than  one  hundred  miles  from  the  chief's  camp. 

"One  day  while  watching  a  Hopi  Indian  dance  near 
Tuba,  I  overheard  a  Navajo  Indian  talking  to  a  bunch 


82  Medicine  as  a  Profession". 

of  Hopi  Indians,  telling  them  how  his  son  had  been 
very  sick  and  that  the  Navajo  Indian  medicine  men 
had  treated  him  and  failed,  but  had  taken  most  all  of 
his  horses,  cattle  and  sheep  for  their  services,  and  how 
he  finally  appealed  for  help  to  the  white  medicine  man 
by  whom  his  boy  was  cured;  I  became  interested  and 
thought  I  would  walk  around  to  a  place  where  I  could 
.get  a  view  of  the  speaker's  face. 

"At  first  glance  I  recognized  him.  I  had  no  more 
than  gotten  my  first  glance  of  the  chief's  face,  when  he 
too  looked  in  my  direction  and  at  once  knew  me.  He 
came  forward  with  right  arm  extended  and  we  clasped 
hands  and  as  he  shook  my  hand  a  smile  of  gratitude 
came  over  that  stern  wTinkled  face  that  I  shall  never 
forget.  I  asked  him  further  about  his  boy,  and  he  said 
that  he  was  well  and  strong  and  able  to  ride  and  lasso 
horses.  He  told  me  that  he  had  heard  that  I  had  moved 
to  Tuba,  and  he  had  come  to  express  their  gratitude  for 
my  services.  I  told  him  that  I  appreciated  his  grati- 
tude for  what  I  had  done,  but  tried  to  explain  to  him 
that  they  owed  much  more  gratitude  to  the  people  of 
the  United  States  and  their  great  government  who  had 
sent  me  there  to  help  those  Indians  who  needed  the  aid 
of  the  white  medicine  man.  A  puzzled  look  appeared 
on  his  face,  and  in  his  own  peculiar  way  he  replied: 
'  You  are  the  only  white  man  who  saw  my  son  while  he 
was  sick,  and  now  he  is  well  and  strong.  We  are  both 
happy,  to  you  we  are  grateful.' " 

A  list  of  these  Indian  Service  Stations  will  be  found 
in  the  Appendix. 


CHAPTER  XIII. 

Sanitakt  Engineering. 

In  the  preceding  chapter  we  referred  to  the  work  of 
the  medical  staff  of  the  Indian  reservations.  We  will 
dwell  at  some  length  upon  the  more  extended  work  which 
has  been  done  by  the  sanitary  engineers  in  the  Panama 
Canal  Zone  and  in  the  Philippine  Islands.  Considering 
the  effectiveness  of  the  work  in  these  regions  as  suggest- 
ing the  possibilities  of  rendering  habitable  large  areas 
of  the  tropics  and  semi-tropics,  one  readily  sees  the 
almost  boundless  fields  which  are  open  to  the  medical 
men  of  the  next  generation. 

The  Isthmian  Canal  Commission  was  organized  for 
the  purpose  of  making  the  Panama  Canal  Zone  safe  for 
those  who  were  to  undertake  the  construction  of  the 
canal.  The  commission  was  vested  with  extensive 
powers  and  the  strictest  kind  of  laws  were  formulated 
for  the  government  of  the  country.  The  medical  staff 
numbers  sixty-nine  physicians.  These  men  receive  an 
entrance  salary  of  $1,800  a  year  with  ample  expense 
allowance. 

The  sanitation  of  the  Canal  Zone  was  the  most  im- 
portant preliminary  work  in  the  building  of  the  canal; 
it  made  the  long-dreamed-of  canal  across  the  isthmus  a 
possibility.  The  story  of  the  conquest  of  disease,  espe- 
cially of  3^ellow  fever  and  malaria,  reads  like  a  fairy 
tale. 

The  great  obstacle  in  the  way  of  the  building  of  the 
canal  by  the  French  Company  was  not  money,  organiza- 

83 


84  Medicine  as  a  Profession. 

tion,  engineers  nor  machinery,  but  a  scarcity  of  men  on 
account  of  the  enormous  losses  by  death.  The  French 
Company  tried  to  build  the  canal  through  this  yellow 
fever  and  malarial  infected  zone — an  impossible  under- 
taking, as  we  now  see  things.  The  project  was  doomed 
to  failure  without  laborers,  and  men  would  not  dare  to 
go  to  work  in  an  atmosphere  infested  with  an  enemy 
that  caused  the  death  of  240  per  year  out  of  every  1,000 
of  the  workmen.  The  problem  of  prime  importance 
was  how  to  make  the  canal  zone  healthy. 

The  Surgeon-General  of  the  United  States  Army 
recommended  Dr.  William  C.  Gorgas,  as  the  best  fitted 
officer  for  the  head  of  the  Sanitary  Commission.  Colonel 
Gorgas  was  the  medical  officer  who  had  charge  of  the 
crusade  against  yellow  fever  in  Havana,  during  the  oc- 
cupancy of  Cuba;  and  under  his  supervision  Havana 
was  freed  from  yellow  fever  for  the  first  time  in  one 
hundred  and  forty  years.  There  was  nothing  miracu- 
lous in  this  performance ;  it  was  but  a  practical  applica- 
tion of  scientific  discoveries.  One  of  these  was  the  dis- 
covery of  the  disseminating  cause  of  yellow  fever.  It 
helps  us  to  understand  this  kind  of  work  to  follow  those 
who  made  this  discovery. 

The  Surgeon- General  of  the  Army  appointed  a  com- 
mission, known  as  the  Reed  Commission,  composed  of 
Drs.  Walter  Eeed,  Jesse  W.  Lazear,  Aristides  Agra- 
monte  and  James  Carroll  to  study  the  disease  and  find 
its  cause.  The  commission  naturally  proceeded  to 
prove  or  disprove  the  theories  which  were  held  regard- 
ing this  disease,  and  to  determine  whether  it  was  spread 
by  transmission  through  air  or  by  infection  in  the  same 
way  as  measles,  scarlet  fever  and  other  communicable 
diseases  are  transmitted.     In  order  to  test  out  this 


Sanitary  Engineering.  85 

source  of  the  disease  an  experimental  camp  was  con- 
structed at  Havana,  which  was  absolutely  insect  proof; 
and  the  volunteers  from  among  the  American  soldiers 
and  doctors  were  housed  in  the  camp  for  twenty  con- 
secutive nights,  sleeping  on  beds  on  which  yellow  fever 
pjatients  had  slept.  There  was  no  effort  made  to  cleanse 
the  bed  linens,  but  instead  of  cleansing,  the  bed  linens 
were  intentionally  soiled  by  the  vomited  matter  of  yel- 
low fever  patients.  The  men  also  donned  night  clothes 
which  had  been  worn  by  persons  who  died  of  yellow 
fever.  One  hears  of  many  heroic  deeds  performed  by 
individuals  and  soldiers  in  the  field,  but  very  few  deeds 
have  been  more  heroic  than  this  test  taken  by  Dr.  Eobert 
P.  Cooke,  U.  S.  A.,  and  six  privates  of  the  hospital 
corps.  Each  one  knew  of  the  fatality  of  yellow  fever. 
None  developed  the  disease.  This  was  conclusive  evi- 
dence that  yellow  fever  was  not  communicated  by  direct 
contact,  but  by  other  channels. 

The  next  clue  investigated  was  one  advanced  by  a 
Dr.  Carlos  Finley,  of  Havana.  It  was  the  "mosquito 
theory.^^  The  preliminary  investigation  showed  very 
strong  evidence  favorable  to  this  theory,  but  conclusive 
evidence  was  lacking  until  an  actual  test  was  made  upon 
human  beings.  While  there  are  about  seven  hundred 
species  of  mosquitoes,  the  evidence  pointed  to  the  stego- 
myia  as  the  species  that  carried  the  disease.  The  com- 
mission procured  eggs  of  this  variety  and  allowed  them 
to  develop  in  captivity.  Upon  studying  this  species  of 
mosquitoes  the  fact  developed  that  the  males  were  not 
equipped  with  a  "hypodermic  needle"  or  sucker,  and 
consequently  could  not  carry  yellow  fever.  It  also  de- 
veloped that  the  mosquito  for  sustenance  needs  only 
vegetable  juices.     A  more  surprising  discovery  was  made 


86  Medicine  as  a  Profession. 

— that  while  the  female  stegomyia  needs  no  animal 
blood  for  sustenance,  she  does  need  it  in  order  to  lay 
eggs.  The  female  did  not  lay  eggs  until  she  sucked 
some  animal  blood.  This  explained  why  the  female 
alone  possessed  this  biting  apparatus. 

The  commission  allowed  the  female  stegomyia,  held 
in  captivity,  the  privilege  of  biting  yellow  fever  patients ; 
and  then  all  was  ready  for  the  test.  Who  were  the  first 
volunteers  deliberately  to  allow  these  mosquitoes  to  bite 
them  in  order  to  prove  or  disprove  a  fanciful  theory? 
Dr.  Carroll  and  Dr.  Lazear,  two  of  the  commissioners 
who  were  conducting  the  investigation,  submitted  them- 
selves. They  both  developed  yellow  fever,  and  Dr.  La- 
zear  died  within  five  days  from  the  time  he  was  stricken. 
"  Almost  at  the  beginning  of  what  promised  to  be  a  life 
full  of  usefulness  and  good  works,  and  d3dng  he  added 
one  more  name  to  that  imperishable  roll  of  honor  to 
which  none  others  belong  than  martyrs  to  the  cause  of 
humanity  '^  quoting  Dr.  Reed's  words. 

This  experiment  was  repeated  with  other  volunteers, 
and  the  mosquito  theory  was  verified.  A  few  heroic 
lives  were  sacrificed,  but  through  this  sacrifice,  Havana 
and  later  Panama  were  ultimately  freed  of  the  dreadful 
scourge,  and  as  a  result  the  Canal  was  built  without  the 
heavy  toll  of  the  days  of  the  French  Canal  Company's 
operations. 

The  United  States  averaged  39,000  employees  on  the 
canal  for  10  years,  with  a  death  rate  of  only  14  per 
1,000.  The  sanitary  commission  of  the  Canal  Zone  had 
to  destroy  all  breeding  places  of  the  mosquito  in  order 
to  eradicate  the  diseases  of  malaria  and  yellow  fever, 
as  both  diseases  are  disseminated  by  mosquitoes,  though 
by  different  species. 


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IiiNKkANT  Physician  at  Work   in  the  Philippinks 


CHAPTER  XIV. 

The  Philippine  Service. 

When  Congress  reorganized  the  government  of  the 
Philippine  Islands,  a  special  medical  service  and  public- 
health  department  was  constituted  to  direct  the  sanita- 
tion; control  the  epidemics;  prevent  the  introduction 
of  plagues;  regulate  the  manufacture  and  sale  of  foods 
and  drugs;  exercise  supervision  of  water  supplies  and 
the  building  of  tenements;  to  establish,  wherever  neces- 
sary, hospitals  and  asylums  and  to  regulate  the  practice 
of  medicine.  In  the  continental  United  States  some  of 
the  governmental  machinery  for  public-health  work  is 
under  the  control  of  the  national  government,  part  of  it 
is  supervised  by  the  state  and  part  by  the  municipalities, 
and  some  by  privately  supported  organizations.  The 
vagaries  of  our  patchwork  system  can  be  more  readily 
understood  after  a  consideration  of  the  complete  mod- 
ern system  which  was  created  for  these  islands. 

When  the  American  army  of  occupation  came  into  the 
islands,  they  found  malaria,  the  bubonic  plague,  typhoid 
fever,  dysentery  and  cholera  everywhere.  The  great 
cities  were  at  once  transformed.  Wholesome  artesian 
water  supplies  were  provided  for ;  sewerage  systems  were 
instituted ;  vermin-infested  old  buildings  were  removed ; 
the  milk  and  food  supplies  were  carefully  inspected; 
dance  halls  and  public  assemblies  were  regulated;  hos- 
pitals and  free  clinics  were  founded ;  medical  and  train- 
ing schools  for  training  native  physicians  and  nurses 
were  instituted;  and  research  laboratories  for  studying 
climatic  conditions  and  tropical  disease  were  established. 

7  87 


88  Medicine  as  a  Profession. 

The  duties  assigned  to  the  bureau  of  public  health 
were  to  include  not  only  those  usually  imposed  upon 
similar  departments  in  the  United  States,  such  as  the 
collection  and  compilation  of  vital  statistics  and  the 
protection  of  the  public  from  communicable  diseases, 
but  also  to  embrace  the  distribution  of  certain  charitable 
f  unfls ;  the  care  of  the  insane ;  the  supervision  of  orphans 
and  the  aged;  the  supervision  of  hospitals,  the  hygienic 
and  medical  care  of  over  12,000  civilian  employees;  the 
administration  of  the  food  and  drug  act;  the  perform- 
ance of  coroner's  duties;  the  examination  of  candidates 
for  the  public  service;  the  supervision  of  sanitary  and 
housing  regulations  and  the  control  of  water  supplies. 

It  will  thus  be  seen  that  the  members  of  this  service 
must  be  skilled  in  administrative  work  as  well  as  in 
medical  practice;  sanitary  engineers  as  well  as  trained 
investigators;  and  that  their  work  is  to  a  much  larger 
extent  preventative  than  curative,  than  in  the  American 
communities,  where  officials  are  hampered  on  all  sides 
by  restrictions.  Abroad  they  are  in  positions  to  work 
out  gradually  such  service  as  progressive  medical  men 
have  been  seeing  in  their  dreams  for  many  years. 

As  the  islands  become  more  prosperous  they  will 
afford,  no  doubt,  fine  fields  for  private  practitioners. 
With  a  population  of  over  8,000,000  there  are  now  only 
620  physicians  in  the  islands,  not  including  the  un- 
trained medical  native  men.  In  Bana,  with  a  popula- 
tion of  39,000,  there  is  only  one  physician ;  in  Batanges, 
with  33,000,  only  four;  in  Baybay,  with  23,000,  only 
one;  in  Cadiz,  with  20,000,  one;  Dumaguete,  with  15,- 
000,  four;  in  Calbyog,  with  16,000,  one;  in  Caragayra, 
with  17,000,  one;  in  Tabaco,  with  22,000,  one;  in  San 
Pablo,  with  22,600,  three ;  and  in  Jaro,  with  10,600,  two. 


The  Philippine  Service.  89 

With  the  influx  of  Europeans  and  Americans,  the 
development  of  manufacturing  industries  and  the  larger 
education  of  the  natives  there  will  be  a  demand  for 
more  trained  men,  not  only  in  these  larger  cities,  but  in 
more  remote  districts. 

The  private  practice  of  medicine  is  regulated  in  the 
same  way  as  in  the  states,  the  bureau  of  health  having 
control  of  the  licensing  of  physicians. 

Applicants  for  admission  to  this  service  and  candi- 
dates for  license  to  practice  in  the  islands  must  be  grad- 
uates of  reputable  medical  colleges  recognized  by  the 
Board  of  Health.  They  must  pass  such  examinations 
as  the  board  directs,  which  include  the  subjects  usually 
prescribed  by  the  board  of  medical  examiners  of  the 
states,  in  addition  to  the  medical  laws  of  the  islands; 
candidates,  of  course,  must  learn  the  languages  which 
are  spoken  in  the  districts  to  which  they  are  sent,  or 
which  they  select  for  practice. 

The  advance  guards  of  modern  science,  by  performing 
in  these  remote  regions  marvelous  changes,  win  such 
rewards  of  gratitude  and  esteem  as  do  the  medical  men 
at  mission  stations,  of  whom  we  will  treat  in  another 
chapter. 

It  was  in  the  Philippine  Service  that  one  of  the 
American  physicians  made  a  discovery  in  medicine  that 
has  been  of  great  service  to  all  mankind — the  use  of 
ipecac  and  its  active  principle  in  the  cure  of  dysentery. 
The  investigation  which  he  conducted  proved  that  the 
disease  was  due  to  the  amoeba,  and  that  the  amoeba 
could  not  live  in  a  system  thoroughly  impregnated  with 
ipecac.  It  was  through  the  further  development  of  this 
discovery  that,  today,  dysentery,  typhoid  fever,  pyor- 
rhea alveolaris,  etc.,  are  treated  much  more  intelligently. 


CHAPTEE  XV. 

The  Federal  Public  Health  Service. 

Under  the  provisions  of  the  constitution  of  the 
United  States  empowering  the  federal  government  to 
regulate  the  admission  of  immigrants  and  to  promote 
the  general  welfare  of  the  people,  from  the  beginning 
of  our  national  existence,  officers  were  stationed  at  the 
chief  points  of  entry  to  prevent  incoming  vessels  from 
landing  plague-stricken  passengers  or  members  of  crews, 
and  gradually,  under  the  supervision  of  the  Department 
of  the  Treasury,  the  United  States  Public  Health  Serv- 
ice has  been  developed.  Few  people  have  any  concep- 
tion of  the  extensive  work  which  is  being  carried  on  by 
this  department,  which  is  just  as  active  in  protecting 
the  people  of  the  country  as  is  the  army  and  navy. 

The  work  of  the  department  is  organized  under  the 
following  divisions:  scientific  research  and  sanitation; 
foreign  and  insular  quarantine  and  immigration;  inter- 
state quarantine ;  sanitary  reports  and  statistics ;  marine 
hospitals  and  relief;  personnell  and  accounts;  miscel- 
laneous. 

Each  of  these  divisions  is  in  charge  of  a  medical 
officer  who  is  responsible  for  its  operations  to  the  sur- 
geon-general of  the  service. 

The  staff  of  the  department  at  the  close  of  the  year 
ending  June  30,  1915,  consisted  of  the  following: 

90 


The  Federal  Public  Health  Service.        91 

Burgeon-general 1      Assistant  surgeons 63 

Assistant  surgeon-general        1      Acting  assistant  surg's.  .    262 

Senior  surgeons 12      Internes 21 

Surgeons 70      Medical  inspector 1 

Passed    assistant    surg  's.      39      Quarantine  inspector  ....        1 
Hospital  and  quarantine  nurses  and  attendants 1,429 

This  service  must  be  attractive,  because  during  the 
year  considered  there  were  no  resignations  from  the 
service,  although  during  the  year  five  officers  were 
placed  under  "waiting  orders"  on  account  of  illness, 
which  means  that  they  were  relieved  from  duty  on  full 
or  half  pay. 

The  rate  of  pay  is  as  follows:  assistant  surgeons  re- 
ceive $2,000;  passed  assistant  surgeons,  $2,400;  sur- 
geons, $3,000;  senior  surgeons,  $3,500;  and  assistant 
surgeon-generals,  $4,000  a  year.  When  quarters  are 
not  provided,  commutation  at  the  rate  of  $30,  $40  and 
$50  a  month,  according  to  the  grade,  is  allowed. 

After  four  years'  service,  assistant  surgeons  are  en- 
titled to  examination  for  promotion  to  the  grade  of 
passed  assistant  surgeon. 

All  grades  receive  longevity  pay,  10  per  cent,  in  addi- 
tion to  the  regular  salary  for  every  five  years'  service 
up  to  40  per  cent,  after  twenty  years. 

The  tenure  of  office  is  permanent.  Officers  travelling 
under  orders  are  allowed  actual  expenses. 

Admission  to  the  service  is  governed  by  the  following 
regulations  contained  in  a  circular  letter  which  is  sent 
to  applicants: 

Boards  of  commissioned  medical  officers  will  be  con- 
vened to  meet  at  the  Bureau  of  Public  Health  Service, 
3  B  Street,  S.E.,  Washington,  D.  C,  for  the  purpose  of 
examining  candidates  for   admission  to  the  grade  of 


92  Medicine  as  a  Profession. 

assistant  surgeon  on  the  Public  Health  Service,  when 
applications  for  examination  at  these  stations  are  re- 
ceived in  the  Bureau. 

Candidates  must  be  between  23  and  32  years  of  age, 
graduates  of  reputable  medical  colleges,  and  must  fur- 
nish testimonials  from  two  responsible  persons  as  to 
their  professional  and  moral  character.  Service  in  hos- 
pitals for  the  insane,  or  experience  in  the  detection  of 
mental  diseases  will  be  considered,  and  credit  given  in 
the  examination.  Candidates  must  have  had  one  years^ 
hospital  experience  or  two  years'  professional  work. 
They  must  be  not  less  than  5  feet,  4  inches,  nor  more 
than  6  feet,  2  inches  in  height. 

The  following  is  the  usual  order  of  the  examination : 
physical,  oral,  written,  clinical.  In  addition  to  the 
physical  examination,  candidates  are  required  to  certify 
that  they  believe  themselves  free  from  any  ailment  which 
would  disqualify  them  for  service  in  any  climate,  and 
that  they  will  serve  wherever  assigned  to  duty. 

The  examinations  are  chiefly  in  writing,  and  begin 
with  a  short  autobiography  of  the  candidate.  The  re- 
mainder of  the  written  exercise  consists  of  examination 
in  the  various  branches  of  medicine,  surgery  and  hy- 
giene. The  oral  examination  includes  subjects  of  pre- 
liminary education:  history,  literature  and  natural 
sciences.  The  clinical  examination  is  conducted  at  a 
hospital.  The  examination  usually  covers  a  period  of 
about  ten  days. 

The  officers  of  the  medical  corps  examine  the  papers  of 
all  incoming  vessels.  The  medical  officer  of  all  ships 
upon  arriving  at  a  port  must  state  the  health  condition 
of  the  port  from  which  the  ship  comes  as  well  as  the 
conditions  of  the  ports  at  which  the  ship  touched  during 


The  Federal  Public  Health  Service.         93 

the  voyage,  and  enumerate  any  cases  of  sickness  which 
occurred  during  the  voyage.  The  medical  inspectors 
may  examine  all  the  passengers  and  crew  and  require 
the  fumigation  of  the  cargo ;  and  in  suspected  cases  they 
may  cause  the  vessel  or  passengers  who  were  exposed  to 
contagion  or  infection  to  be  detained  in  quarantine  suffi- 
ciently long  to  give  any  suspected  diseases  the  full 
period  of  time  to  develop. 

The  department  may  also  send  inspectors  to  suspected 
foreign  ports  to  scrutinize  cargo,  crew  and  passengers 
of  vessels  destined  for  American  ports,  to  prevent  the 
spread  of  communicable  diseases. 

Officers  are  stationed  as  sanitary  guards  at  Santiago, 
Chile;  Callao,  Peru;  Guayaquil,  Ecuador;  Eio  de 
Janeiro,  Brazil ;  La  Guaira,  Venezuela ;  Calcutta,  India ; 
Naples,  Italy;  Libau,  Eussia  and  in  several  Cuban  and 
Mexican  ports,  and  in  such  other  foreign  ports  as 
deemed  necessary. 

One  can  hardly  appreciate  the  value  of  the  service 
which  the  government  is  rendering  to  its  people  through 
this  department.  Although  Asiatic  ports  from  which 
vessels  sail  are  often  infected  with  bubonic  plague, 
cholera,  smallpox  or  other  diseases,  yet  these  diseases 
have  only  on  a  few  occasions  been  introduced  into  this 
country.  Several  years  ago  bubonic  plague  did  develop 
upon  the  Pacific  coast,  and  but  for  the  persistent, 
thorough  work  of  these  medical  officers,  the  whole  coun- 
try from  coast  to  coast  might  have  been  infected. 

This  work  at  the  ports  of  entry  is  not  by  any  means 
all  the  work  that  is  done  in  disease  prevention  by  this 
department,  but  investigations  of  disease  epidemics  are 
carried  on  continually.  During  1914,  important  inves- 
tigations of  typhoid  fever,  cholera,  plague,  smallpox. 


94  Medicine  as  a  Profession. 

typhus  fever,  tuberculosis,  trachoma,  pellagra,  poliomye- 
litis, malaria,  dengue,  hookworm  disease,  water  pollu- 
tions and  milk  hygiene  have  been  conducted. 

The  officer  detailed  to  investigate  the  disease  among 
the  mountain  whites  in  Tennessee,  and  among  the 
natives  of  Porto  Eico,  known  as  the  "  lazy "  disease,  be- 
cause all  the  inhabitants  afflicted  with  the  disease  became 
lazy,  indolent  and  sleepy,  found  the  cause  of  the  disease 
to  be  a  hookworm.  The  officer  detailed  to  this  investi- 
gation also  developed  a  treatment  for  the  cure  of  these 
afflicted  mountain  whites. 

Another  officer  was  detailed  to  investigate  the  Eocky 
Mountain  spotted  fever,  and  found  the  cause  to  be  a 
microorganism  disseminated  by  a  tick.  The  name  of 
Surgeon  T.  B.  McClintic,  who  sacrificed  his  life  to  the 
cause  of  science  in  order  that  this  fever  might  be  eradi- 
cated, belongs  with  those  heroes  who  have  given  up 
their  lives  for  the  common  good  of  mankind. 

Until  recent  years,  there  was  possibly  no  familiar  dis- 
ease that  was  as  little  understood  by  the  public  and  phy- 
sicians as  rabies.  The  public  health  service  detailed  an 
officer  to  investigate  this  disease,  its  cause,  localities  and 
treatment.  His  report  clears  up  the  mysteries  of  the 
disease,  and  will  eventually  aid  in  its  complete  eradica- 
tion. 

The  department  maintains  a  hygienic  laboratory 
where  much  of  the  work  in  connection  with  these  inves- 
tigations is  carried  on.  In  this  laboratory  the  trained 
men  of  the  service  also  determine  the  merits  of  the  new 
medical  discoveries  which  are  announced  from  time  to 
time,  and  valuable  service  has  been  rendered  to  the 
public  in  exposing  frauds. 


The  Federal  Public  Health  Service.        95 

There  are  also  maintained  22  hospitals  on  the  sea- 
coasts,  lakes  and  rivers  for  the  care  of  seamen.  During 
the  year  closing  June  20,  1915,  40,604  seamen  were 
treated  at  the  various  stations.  Of  this  number  over 
14,000  were  treated  in  hospitals  owned  by  the  govern- 
ment. The  marine  hospitals  are  located  at:  Mobile, 
Ala. ;  San  Francisco,  Cal. ;  Delaware  Break  Water ;  Key 
West,  Fla. ;  Cairo,  111.;  Chicago;  Evansville,  Ind. ; 
Louisville ;  New  Orleans ;  Portland,  Me. ;  Boston ;  Vine- 
yard Haven,  Mass. ;  Baltimore ;  St.  Louis ;  Wilmington, 
Del.;  New  York;  Memphis;  Cape  Charles,  Va. ;  Port 
Townsend,  Wash. 

Assistant  surgeons,  whether  in  quarantine  stations, 
marine  hospitals,  hygiene  laboratory  or  in  field  service, 
work  under  the  direction  of  their  superior  officers;  and 
they  must  accustom  themselves  to  such  a  rigorous  sys- 
tem of  routine  of  work  and  report  as  is  unknown  to  the 
general  practitioner.  Passed  assistant  surgeons  are 
more  independent,  and  they  may  be  assigned  to  special 
duty  in  connection  with  the  other  departments  of  the 
government  or  in  cooperation  with  the  health  service  of 
the  several  states  and  cities.  Whenever  they  are  as- 
signed to  special  duty  with  other  branches  of  the  govern- 
ment, the  medical  officers  are  accorded  the  honor  due 
to  officers  of  the  highest  rank. 

The  rank  of  surgeon  can  only  be  attained  by  promo- 
tion as  vacancies  occur,  and  then  only  by  seniority. 


CHAPTER  XVI. 

The  Public  Health  Service. 

Unlike  the  well-organized,  unified  public  health  and 
medical  service  of  the  Philippines,  the  machinery  for 
doing  this  work  in  the  States  is  not  always  so  well  co- 
ordinated. This  is  because  the  functions  which  the 
state  and  local  governments  exercise  in  these  fields  have 
grown  from  the  very  insignificant  beginnings  which  date 
back  to  the  organization  of  our  government,  when  men 
acknowledged  little  collective  responsibility  for  the  wel- 
fare of  their  fellows.  These  functions  of  government 
deal  with  the  protection  of  the  citizens  from  infection 
and  contagion,  from  contaminated  food  supplies  and 
polluted  waters.  These  functions  are  exercised  by  the 
boards  of  health  of  the  larger  cities  within  their  own 
areas,  and  by  the  state  boards  of  health  through  local 
officers  in  the  country  districts.  The  state  medical  serv- 
ice generally  has  to  do  with  ministering  to  the  inmates 
of  state  institutions,  and  the  county  and  city  medical 
service  take  care  of  the  needs  of  those  in  institutions 
under  the  jurisdiction  of  the  local  governments;  while 
in  many  states  there  is  a  separate  medical  service  for 
the  poor  which  is  administered  through  the  boards  for 
poor  relief  and  charity. 

This  work  is  as  yet  very  unevenly  developed  and  prac- 
tices vary  in  the  several  states.  To  convey  an  idea  of 
the  operations  of  these  branches  of  government  and  to 
show  the  large  possibilities  in  this  field,  a  somewhat  de- 

96 


The  Public  Health  Service.  97 

tailed  description  is  given  of  the  organization  and  opera- 
tions of  the  department  of  health  of  the  state  and  city 
of  New  York. 

The  state  paid  in  1914,  to  sanitary,  medical  and 
scientific  officers  connected  with  the  board  of  health  and 
other  departments  of  the  state  and  county  governments 
and  to  medical  officers  of  institutions,  over  half  a  mil- 
lion dollars;  and  in  the  one  single  large  city  of  New 
York  the  expenditures  of  the  department  of  health 
alone  were  $3,363,767.85. 

The  state  has  a  commissioner  of  public  health  with  an 
annual  salary  of  $8,000 ;  deputy  commissioner,  at  $5,000 
and  an  advisory  council  of  eight  members,  each  of  whom 
receives  $1,000. 

There  is  a  department  of  sanitation  and  hygiene, 
which  passes  upon  the  plans  for  water  supply  systems 
and  sewerage  systems  of  cities  and  villages,  investigates 
complaints  of  stream  pollution,  and  looks  into  the  causes 
of  t}^hoid  fever  epidemics.  This  is  in  charge  of  a 
chief  sanitary  engineer  with  a  corps  of  trained  assistants 
who  cover  the  state. 

The  department  of  laboratories  and  research  has 
charge  of  the  preparation  and  distribution  of  antitoxins. 
Its  medical  officers  and  bacteriologists  are  at  the  com- 
mand of  the  physicians  and  health  officers  of  the  state. 

The  division  of  child  hygiene  supervises  the  child 
welfare  agencies  of  the  state  and  the  public  and  private 
schools. 

The  department  of  vital  statistics  collects  from  the 
county  officers  of  health,  statistics  relating  to  births  and 
deaths. 

The  department  of  publicity  and  public  health  educa- 
tion employs  a  corps  of  lecturers,  issues  bulletins  of  in- 


98  Medicine  as  a  Profession". 

formation  for  the  people  and  plans  and  manages  exhibits 
intended  to  arouse  the  people  to  the  necessity  of  sanita- 
tion and  hygiene. 

The  division  of  communicable  diseases  is  constantly 
on  the  watch  for  any  outbreaks,  and  is  prepared  to  check 
and  control  the  spread  of  disease,  in  the  same  way  that 
a  fire  department  operates  or  the  state  militia  acts  when 
an  enemy  threatens  the  peace  and  comfort  of  the  people. 

Another  department  regulates  and  supervises  the 
operation  of  cold  storage  plants  and  the  distribution  of 
food  from  these  places. 

The  psychiatric  institute  and  the  institute  for  the 
investigation  of  malignant  diseases  have  their  own 
organization  of  experts  and  their  own  laboratories. 

The  heads  of  these  several  departments  are  paid 
$4,000  a  year,  the  assistant  directors  $3,000,  and  the 
members  of  the  scientific  forces,  whether  physicians, 
bacteriologists,  chemists  or  sanitary  experts,  are  selected 
by  competitive  examinations  with  salaries  ranging  from 
$1,200  to  $2,500. 

The  health  officer  of  the  port  of  New  York  is  a  state 
official  who  is  paid  $12,500  a  year,  and  has  a  deputy  at 
$4,000  and  three  assistants  at  $3,000.  These  men  have 
perhaps  the  most  autocratic  power  of  any  officials  in  our 
system  of  government. 

Outside  of  the  department  of  health  the  state  has  a 
medical  adviser  to  the  workingmen's  compensation  com- 
mission at  $4,000  a  year,  a  medical  examiner  at  $3,000 
and  an  assistant  at  $2,000. 

The  superintendents  of  the  state  insane  asylums  re- 
ceive from  $4,800  to  $6,000  with  maintenance,  and  the 
physicians  from  $1,200  to  $2,800.  The  physicians  to 
the  school  for  the  blind  and  the  deaf,  the  homes  for 


The  Public  Health  Service.  99 

epileptics  and  feeble-minded,  the  houses  of  detention 
and  the  prisons  of  the  state,  are  designated  to  act  as 
such  from  among  the  practising  physicians  of  the  com- 
munities in  which  these  institutions  are  located,  and 
they  change  whenever  the  political  complexion  of  the 
state  government  changes. 

Much  of  the  work  of  the  state  department  is  done 
through  physicians  who  act  as  local  health  officers  and 
who  are  paid  according  to  the  amount  of  time  which 
they  give  to  this  service.  The  county  board  of  health 
officers  usually  act  as  reporters  of  conditions  to  the  state 
board  of  health,  and  direct  the  medical  service  for  the 
relief  of  the  poor. 

The  most  completely  developed  public  health  systems 
are  found  in  our  large  cities.  In  the  city  of  New  York 
in  1915  the  total  number  of  employees  of  the  depart- 
ment of  health  was  3,421.  Of  course,  all  of  these  were 
not  medical  officers,  but  a  description  of  the  work  of  this 
department  will  show  how  rapidly  this  new  field  for 
medical  men  is  expanding. 

The  commissioner  of  health,  the  chief  of  police  and 
the  health  officer  of  the  port  constitute  the  board  of 
health.  There  is  also  an  unpaid  medical  advisory  board, 
and  a  board  of  honorary  consultants.  The  head  of  the 
administrative  force  is  the  commissioner  of  health 
($8,000),  a  sanitary  superintendent  ($7,000),  and  a 
secretary  to  the  board  of  health  ($5,000).  The  force  in 
the  office  of  the  secretary  handles  the  correspondence, 
keeps  the  records,  attends  to  the  purchase  and  distribu- 
tion of  supplies  and  audits  the  accounts  of  the  depart- 
ment. It  is  made  up  of  men  and  women  whose  train- 
ing has  been  along  commercial  lines. 

The  registrar  of  vital  statistics  ($5,000)  and  his  5 


100  Medicine  as  a  Profession. 

assistants  ($3,000)  are  medical  men.  They  superin- 
tend the  collection  of  statistics  of  births,  deaths  and  mar- 
riages, issue  burial  permits  and  make  searches  for  miss- 
ing persons.  In  the  department,  in  addition  to  a  force 
of  53  clerks,  copyists  and  stenographers,  there  are  four 
medical  clerks  ($1,200),  and  a  medical  inspector 
($1,500). 

The  superintendent  of  the  sanitary  department  in- 
vestigates complaints  about  noises  which  disturb  the 
comfort  of  people,  supervises  dangerous  trades,  has 
charge  of  the  suppression  of  mosquitoes  and  the  removal 
of  the  bodies  of  the  dead  animals.  His  force  consists 
of  five  sanitary  supervisors  ($3,500)  and  a  force  of  med- 
ical and  sanitary  inspectors  ($l,200-$2,550). 

The  bureau  of  infectious  diseases  collects  from  physi- 
cians the  reports  of  the  appearance  of  such  diseases, 
issues  a  daily  bulletin  showing  their  location,  estab- 
lishes and  enforces  the  observance  of  quarantine  regula- 
tions, disinfects  premises,  disinfects  or  directs  the  de- 
struction of  infected  goods,  attends  to  the  vaccination  of 
patients  in  public  institutions,  supervises  the  tubercular 
hospitals  and  camps,  and  the  laboratory  for  Pasteur 
treatment.  The  medical  staff  consists  of  a  director 
($5,000),  an  assistant  director  ($4,000),  5  chiefs  of 
divisions  ($3,500),  4  borough  chiefs,  17  physicians  in 
charge  of  branch  offices  and  hospitals,  44  medical  in- 
spectors ($1,200  to  $3,000),  62  attending  physicians 
($300  to  $600),  besides  a  force  of  bacteriologists  and 
laboratory  assistants. 

The  bureau  of  laboratories  attends  to  the  manufac- 
ture of  vaccine  virus,  antitoxines  and  other  biologic 
products  which  are  used  for  the  diagnosis,  prevention 
and  treatment  of  diseases.     There  is  a  clinical  depart- 


The  Public  Health  Service.  101 

nient  which  advises  and  instructs  physicians  in  the  use 
of  these  products;  a  laboratory  for  the  examination  of 
food  and  milk ;  a  laboratory  which  makes  bacteriological 
examinations  for  other  departments  and  for  physicians. 
The  medical  staff  consists  of  a  director,  7  assistant 
directors,  25  bacteriologists  and  42  laboratory  assistants, 
all  of  whose  pay  corresponds  with  the  pay  for  services 
of  the  same  kind  in  other  departments. 

The  bureau  of  child  hygiene  is  in  charge  of  a  director 
($3,000),  an  assistant  director  ($2,550)  and  5  chiefs  of 
divisions,  5  borough  chiefs  and  14  supervising  inspec- 
tors. There  are  98  school  medical  inspectors  ($1,200- 
$1,500)  :  9  examiners  for  employment  certificates;  7 
inspectors  of  child  welfare  institutions;  18  attendants 
at  clinics  for  school  children;  and  a  large  force  of  non- 
medical assistants,  inspectors  and  nurses,  attendants  at 
milk  stations,  orderlies,  watchmen  and  cleaners.  This 
department  looks  after  the  medical  inspection  of  school 
children,  conducts  55  milk  stations  for  the  distribution 
of  properly  prepared  milk  for  infants,  supervises  the 
midwives,  operates  clinics  for  children  and  controls  day 
nurseries,  and  issues  emplo}Tnent  certificates  to  the  chil- 
dren who  leave  school. 

The  director  of  the  bureau  of  food  inspection  makes 
and  enforces  the  regulations  for  the  manufacture  and 
sale  of  food  products,  including  milk  and  beverages, 
and  the  sale  of  drugs  and  patent  medicines.  Samples 
of  milk  are  taken  at  the  dairies  and  frequently  ex- 
amined, and  regulations  are  made  for  safeguarding  of 
the  milk  supplies.  Over  4,000  bakeries  are  regularly 
visited  and  inspected,  slaughter  houses  and  retail  meat 
markets  are  also  under  the  jurisdiction  of  this  bureau. 


102  Medicine  as  a  Profession. 

The  entire  force  of  the  department  in  1915  was  152,  but 
only  a  few  of  the  chief  officers  were  medical  men. 

There  are  only  three  medical  men  in  the  staff  of  the 
bureau  of  publicity.  During  the  year  1914,  this  depart- 
ment gave  lecture  courses  to  medical  and  food  inspectors 
and  to  nurses,  noonday  talks  to  factory  employees,  con- 
ducted an  anti-tuberculosis  campaign,  managed  several 
important  health  exhibits  and  distributed  over  200  dif- 
ferent health  bulletins.  The  bureau  of  hospitals  of  the 
department  of  health  conducts  three  hospitals  for  con- 
tagious diseases  and  one  country  tuberculosis  hospital  or 
camp.  While  there  are  over  a  thousand  employees 
under  the  jurisdiction  of  the  bureau,  the  medical  staff 
consists  of  a  director,  26  hospital  physicians  and  a  vary- 
ing number  of  internes  and  medical  inspectors.  The 
hospital  physicians  receive  from  $1,200  to  $1,800  and 
maintenance,  and  internes  $120  a  year  and  maintenance. 

This  elaborate  organization  does  not  include  the  entire 
medical  service  under  the  direct  control  of  the  city.  The 
independent  Bellevue  and  Allied  Hospitals  under  the 
direction  of  a  superintendent  ($6,000),  director  of  labo- 
ratories ($5,000),  and  assistant  medical  superintendent 
($2,500),  has  4  attending  physicians  giving  part  time 
service  ($1,000),  38  out-patienfs  physicians  ($600  to 
$900),  and  a  force  of  pathologists,  radiographers  and 
laboratory  assistants. 

There  are  also  four  medical  examiners  for  the  school 
department  who  pass  upon  the  physical  qualifications  of 
applicants  for  appointment  to  the  teaching  staff,  25 
surgeons  of  the  police  department  ($3,500),  and  11 
visiting  physicians  to  prisons  ($1,200-$1,800).  The 
department  of  charities  has  a  medical  superintendent 
($6,000).     The  superintendents  of  the  hospitals  under 


1 


i 


The  Public  Health  Service.  103 

the  control  of  this  branch  of  the  city  government  are 
paid  $4,000,  and  the  physicians  from  $1,200  to  $2,550. 

This  elaborate  organization  has  been  gradually  de- 
veloped. At  present,  dental  clinics  for  school  children 
are  being  tried  under  the  auspices  of  voluntary  organi- 
zations. If  this  experimental  work  proves  successful, 
this  work  will  become  one  of  the  functions  of  the  city 
government.  Just  in  this  way  the  work  of  the  depart- 
ment of  public  health  has  been  extended  in  this  city  and 
is  now  being  extended  in  all  leading  states  and  cities. 
It  has  fully  justified  itself  not  only  in  this  but  in  Euro- 
pean countries.  The  whole  movement  is  a  part  of  the 
movement  for  increasing  and  promoting  the  economic 
efficiency  of  all  citizens,  and  it  is  a  result  of  the  recent 
discoveries  concerning  the  real  causes  of  infectious  and 
contagious  disease.  These  discoveries  have  shown  that 
these  public  health  measures  must  be  supported  by  the 
citizen,  not  alone  to  help  his  fellow  but  for  his  own  pro- 
tection. At  present,  however,  in  most  of  the  cities  this 
kind  of  work,  to  which  the  public  is  committed,  is  but 
partially  done.  In  the  matter  of  school  medical  inspec- 
tion, it  will  be  readily  seen  that  98  medical  inspectors  for 
the  examination  of  over  900,000  school  children  is  a  very 
small  number  with  which  to  realize  the  ideals  of  the  pro- 
moters of  this  kind  of  public  service;  every  day  we 
realize  that  while  the  principle  of  food  inspection  is  a 
good  one,  the  provisions  which  have  been  made  for  the 
inspection  of  retail  food  stores  are  wholly  inadequate. 
All  this  means  that  this  field  will  be  greatly  expanded 
during  the  coming  decades. 

The  heads  of  these  public-service  departments  are 
usually  appointed  from  among  the  men  who  have  estab- 
lished reputations  and  are  specialists  in  their  subjects; 
8 


104  Medicine  as  a  Profession. 

but  frequently  the  appointments  are  made  because  of 
political  favoritism.  In  most  of  the  states  and  cities  the 
subordinates  are  selected  by  civil-service  tests  which  are 
open  alike  to  men  and  to  women.  Young  medical  men 
who  accept  appointments  of  this  kind  serve  for  a  limited 
number  of  years  and  then  turn  to  private  practice.  In 
the  past  it  has  been  the  custom  of  these  public  officials 
gradually  to  build  up  a  private  practice  while  holding 
public  appointments.  This  cannot  at  present  be  done 
so  well.  The  salaries  which  are  paid  in  the  public  serv- 
ice are  gradually  being  increased,  and  the  public  is  de- 
manding full  service  from  its  employees. 

These  salaries  are  likely  to  be  increased  as  the  demand 
for  trained  and  experienced  men  grows.  That  the  sup- 
ply of  such  at  present  is  not  equal  to  the  demand  is 
proven  by  the  fact  that  special  postgraduate  courses  for 
health  officers  have  been  established  by  Harvard  Uni- 
versity, Tulane  University  and  the  universities  of  Penn- 
sylvania, Michigan  and  Wisconsin. 

At  present  the  positions  in  the  public  medical  service 
which  are  under  civil-service  regulation  are  open  to 
graduates  of  recognized  medical  colleges  under  about 
the  same  terms  as  those  under  which  they  enter  the  ex- 
aminations for  licenses  to  practice  medicine,  but  for  the 
sake  of  efficiency  the  new  recruit  for  these  services  is 
gradually  shifted  to  special  work  and  the  service  itself 
has  opened  up  many  new  lines  of  specialization. 


CHAPTER  XVII. 

Hospital  Service. 

There  are  nearly  5,000  hospitals,  public  and  private, 
in  the  United  States,  to  say  nothing  of  the  large  num- 
ber of  hospitals  which  are  maintained  by  corporations 
for  the  treatment  of  their  employees.  The  operations 
of  the  hospital  staff  of  the  Southern  Pacific  Railroad 
for  1914  show  a  total  of  81,525  cases.  This  great  de- 
velopment of  this  kind  of  service  in  all  sections  of  the 
country  calls  for  specialists  in  hospital  administration. 
The  general  practice  of  medicine  is  not  such  as  to  give 
men  a  chance  to  develop  executive  power  while  getting 
experience  in  actual  practice;  so  for  this  reason  the  de- 
mand for  men  in  this  service  is  greater  than  the  supply, 
and  with  the  continued  increase  in  the  number  of  hos- 
pitals this  is  likely  to  continue. 

The  real  development  of  the  modern  general  hospital 
for  the  treatment  of  disease  dates  back  to  1861,  when 
Lister  gave  to  the  world  the  germ  cause  of  wound  infec- 
tion. He  proved  that  wounds,  whether  accidental  or 
surgical,  will  heal  quickly  if  kept  free  from  bacterial 
contamination.  Before  this  discovery  all  kinds  of  oint- 
ments and  plasters  were  applied  to  wounds;  today  the 
applications  which  are  made  are  intended  to  destroy  or 
to  prevent  bacterial  growths ;  and  going  upon  the  prin- 
ciple that  nothing  is  clean  which  has  not  been  sterilized, 
the  modern  hospital  has  sprung  into  existence.  Con- 
ditions have  been  created  under  which  the  patients  can 

105 


106  Medicine  as  a  Profession. 

be  surrounded  with  that  absolute  cleanliness  which  is  of 
prime  importance. 

Modern  hospitals  for  the  treatment  of  the  sick,  as 
distinguished  from  asylums  and  hospitals  for  defectives 
and  dependents,  may  be  built  and  supported  by  public 
taxation,  and  have  free  wards  for  the  treatment  of  the 
poor;  they  may  be  built  by  private  subscriptions  and 
supported  by  fixed  charges  or  they  may  be  built  partly 
by  subscriptions  and  partly  by  public  funds  and  sup- 
ported by  appropriations  from  the  public  funds  and  by 
fees. 

In  the  smaller  communities  the  general  hospital  may 
admit  all  kinds  of  cases  and  have  a  surgical  and  a  med- 
ical department,  each  of  which  has  its  subdivisions  for 
treating  special  types  of  cases.  In  large  cities  there 
may  be  special  hospitals  with  their  own  rules  and  regu- 
lations, which  are  especially  designed  to  facilitate  the 
handling  of  particular  infirmities. 

The  management  of  hospitals  is  usually  vested  in  a 
board  of  trustees  appointed  by  the  governor  in  the  case 
of  state  institutions;  by  the  mayor  or  health  board  in 
the  case  of  city  institutions ;  and  in  various  ways  in  the 
case  of  private  or  semi-public  institutions.  These  trus- 
tees have  the  entire  control  of  the  business  management, 
the  appointment  of  the  superintendent  and,  sometimes, 
the  staff  of  physicians;  but  recently  the  tendency  has 
been  to  give  the  appointment  of  subordinates  to  the 
superintendent. 

The  superintendent,  although  the  executive  head,  is 
not  expected  to  render  medical  service;  but  he  may 
direct  the  internes  in  the  treatment  of  surgical  cases  in 
the  absence  of  the  chief  surgeon.  Although  the  super- 
intendent of  the  public  hospitals  is  usually  appointed 


Hospital  Service.  107 

because  of  his  political  affiliations,  he  is  rarely  disturbed 
if  his  party  goes  out  of  power  while  he  is  in  office.  An 
educated  public  sentiment  is  beginning  to  recognize  that 
officials  whose  value  depends  upon  their  experience  shall 
not  be  removed  from  positions  which  they  are  satisfac- 
torily filling. 

The  successful  hospital  superintendent  is  a  man  of  a 
high  type  of  administrative  ability.  His  medical  staff 
consists  of  a  visiting  body  of  practicing  physicians 
among  whom  jealousy  may  develop  discords;  the  house 
physicians  are  young  physicians  who  are  continually 
changing  and  the  internes  remain  hardly  long  enough  to 
learn  the  regulations  of  the  institution;  the  patients 
come  and  go ;  confiicts  may  arise  between  the  practicing 
physicians  who  bring  their  patients  to  the  private  wards ; 
and  the  supervision  of  nursing  requires  discipline  of  the 
strictest  kind.  So  we  have  a  call  here  for  a  physician 
with  medical  knowledge  and  skill  sufficiently  extended 
to  command  the  confidence  of  the  best  of  his  profession ; 
diplomacy  and  tact  to  bar  all  discordant  influences; 
sympathy  for  the  suffering  and  their  friends ;  and  ability 
to  manage  his  internal  affairs  with  the  strong  hand  of 
rigid  discipline. 

The  internes,  who  are  selected  from  among  the  grad- 
uates of  the  medical  colleges,  usually  serve  for  a  year. 
The  house  physician  begins  his  service  as  a  junior  or 
assistant,  and  in  due  time  takes  the  place  of  the  retiring 
senior.  The  service  is  so  arranged  that  the  house  phy- 
sicians serve'  in  turn  in  the  different  departments,  in 
order  that  they  may  get  actual  experience  in  the  treat- 
ment of  all  kinds  of  medical  and  surgical  cases.  The 
pay  in  the  hospitals  follows  generally  the  schedules  given 
in  the  preceding  chapters. 


108  Medicine  as  a  Profession. 

The  hospitals  for  defectives,  whether  public  or  pri- 
vate, require  men  with  special  training.  The  physicians 
as  well  as  the  superintendents  are  more  permanent  and 
give  their  whole  time  to  the  service.  The  pay  is  fairly 
remunerative  and  the  work  appeals  especially  to  those 
who  dislike  the  business  side  of  private  practice.  The 
work  in  the  insane  hospitals  from  the  medical  view- 
point is  very  interesting,  and  it  is  such  as  to  satisfy 
the  best  of  altruistic  instincts. 

The  work  in  these  institutions  is  more  systematic 
than  in  general  practice  or  the  work  of  the  general  hos- 
pital to  which  patients  continually  come.  An  insane 
asylum  has  from  four  to  ten  regular  physicians  for 
each  thousand  patients.  This  gives  opportunities  for 
close  and  careful  study  of  cases,  and  for  keeping  careful 
and  systematic  records.  Ample  clinical  facilities,  labo- 
ratories and  libraries  are  supplied. 

Upon  arrival  a  patient  is  kept  in  the  reception  wards 
for  examination;  and  in  due  time  a  staff  conference 
classifies  him,  prescribes  his  treatment  and  assigns  him 
to  the  care  of  some  particular  physician. 

In  the  New  York  hospitals  for  the  insane,  the  pay 
for  superintendents  is  from  $4,800  and  maintenance  to 
$6,000  in  the  larger  hospitals.  The  present  heads  of 
these  institutions  in  the  state  average  seventeen  years 
of  service;  the  physicians,  receiving  from  $1,200  to 
$2,800  and  maintenance,  average  very  short  periods  of 
service,  except  the  women  physicians.  In  1914  there 
were  17  receiving  from  $1,200  to  $1,600,  and  averaging 
11  years  of  service. 

It  may  be  interesting  to  note  that  as  the  public  has 
been  educated  to  the  wisdom  of  supporting  the  unfor- 
tunate poor  insane  in  public  hospitals,  there  has  been  a 


Hospital  Service.  109 

corresponding  increase  in  the  number  of  private  hos- 
pitals and  sanitariums  for  the  treatment  of  the  nervous 
disorders  of  the  members  of  families  in  better  circum- 
stances. These  hospitals  are  comparatively  small,  and 
the  physicians  have  more  general  responsibility  than 
in  the  public  hospitals  in  which  the  work  is  more 
specialized. 

Sanatoriums  for  the  treatment  of  chronic  diseases 
are  becoming  more  numerous  and  offer  opportunities 
for  physicians.  As  the  public  has  begun  to  appreciate 
the  modern  hospitals  with  all  conveniences  and  equip- 
ments as  the  best  places  for  the  treatment  of  acute  dis- 
eases, so,  too,  it  is  appreciating  the  modern  sanatoriums 
for  handling  chronic  diseases.  The  sanatoriums  are 
specialized  institutions,  and  admit  only  cases  of 'the 
special  class  for  which  they  are  equipped.  The  climate, 
location,  surrounding  and  equipment  are  all  selected  so 
as  to  conduce  to  the  comfort  and  speedy  recovery  of  the 
patients.  A  dry  atmosphere,  an  even  temperature,  con- 
tinuous sunshine  and  pure  air  are  very  vital  factors  in 
the  treatment  of  tuberculosis;  so  for  this  reason  the 
sanatoriums  for  the  treatment  of  tuberculosis  are  mostly 
found  in  Colorado,  New  Mexico  and  Arizona. 

The  sanatoriums  for  the  treatment  of  arthritis,  rheu- 
matism or  gouty  diseases  are  usually  located  at  some 
saline  or  lithia  springs.  In  this  class  of  cases  the 
climate  is  immaterial,  but  the  medicinal  drinking  water 
is  necessary,  and  the  rest  of  the  equipment  can  be  sup- 
plied. The  sanatoriums  are  therapeutically  classified 
according  to  the  diseases  treated,  as  follows:  asthmatic 
affections;  auto-intoxication;  anemia  and  general  de- 
bility; Bright's  Disease;  catarrhal  diseases  of  the  di- 


110  Medicine  as  a  Peofession. 

gestive  tract ;  catarrhal  diseases  of  the  nose,  throat,  ears, 
respiratory  tract;  chronic  alcoholism;  chronic  articular 
rheumatism ;  chronic  malarial  poisoning ;  chronic  metal- 
lic poisoning;  diabetes  mellitus;  gouty  affections;  heart 
disease;  liver  and  gall  duct  affections;  nervous  diseases 
and  neurasthenia;  tuberculosis;  syphilis;  and  skin 
diseases. 

One  may  readily  see  the  opportunities  these  institu- 
tions offer  to  those  who  wish  to  specialize  in  any  one  of 
these  lines  of  internal  medicine.  This  is  especially  true 
in  the  treatment  of  nervous  diseases,  because  nearly  all 
physicians  and  the  public  generally  appreciate  the  fact 
that  to  treat  nervous  or  neurasthenic  patients  success- 
fully, they  must  be  taken  away  from  their  everyday 
environment ;  and  for  this  reason  the  field  of  sanatorium 
practice  is  promising.  The  fees  obtainable  in  such  a 
field  vary  with  the  institutions.  In  most  cases  the 
sanatoriums  have  been  organized  and  are  managed  by 
physicians  as  the  head  of  stock  companies.  The  figures 
showing  their  net  earnings  have  not  been  obtainable. 

Many  young  physicians  may  be  forced  to  accept  posi- 
tions which  will  prove  immediately  remunerative.  Ap- 
pointments to  private  sanatoriums  are  not  difficult  to 
secure  and  although  the  salary  may  be  low,  the  experi- 
ence is  valuable  and  comfortable  maintenance  is  as- 
sured. A  list  of  these  privately  controlled  institutions 
will  be  found  in  the  Appendix. 


Hospital  Service. 


Ill 


Number  of  Hospitals  in  1916. 


Ala..., 
Ariz.., 
Ark.., 
Cal..., 
Colo.. 
Conn. 
Del.... 
D.  C. 
Fla.... 
Ga.... 
Idaho 

111 

Ind... 

la 

Kan.. 
Ky.... 

La 

Me.... 

Md..., 

Mass. 

Mich. 

Minn 

Miss.. 

Mo.... 

Mont. 


Hos- 
pitals. 

Private 

Sana- 

toriums. 

7 

64 

51 

9 

62 

18 

422 

109 

95 

17 

90 

22 

13 

1 

70 

1 

42 

16 

98 

31 

57 

3 

240 

40 

72 

22 

183 

18 

116 

11 

99 

14 

63 

8 

48 

6 

123 

20 

242 

48 

226 

28 

227 

23 

35 

13 

207 

34 

76 

2 

Nebr.... 

Nev 

N.  H.... 
N.  J..  .. 
N.  Mex 
N.  Y.... 

N.  C 

N.  Dak. 

O 

Okla 

Ore 

Pa 

R.I 

S.  C 

S.  Dak.. 
Tenn. ... 

Tex 

Utah..., 

Vt 

Va 

Wash... 
W.Va.. 

Wis 

Wy 


Hos- 
pitals. 

Private 
Sana- 
tori  urns. 

108 

10 

30 

0 

56 

5 

77 

17 

21 

13 

611 

86 

94 

28 

57 

2 

341 

34 

51 

21 

85 

19 

468 

46 

52 

2 

46 

7 

47 

3 

101 

15 

113 

78 

32 

3 

25 

5 

119 

15 

165 

21 

58 

8 

109 

22 

CHAPTEE  XVIII. 

Laboeatoey  Woek. 

The  changes  which  have  been  made  in  the  practice  of 
medicine  by  the  advances  in  biology,  physics  and  chem- 
istry have  greatly  increased  the  amount  of  laboratory 
work  which  must  be  done  for  the  average  practicing 
physician. 

The  older  physicians  neither  have  the  training  nor 
the  inclination  to  do  this  work  for  themselves;  and  in 
hospital  organization,  efficiency  calls  for  specialists  in 
this  line.  These  laboratory  specialists  need  not  neces- 
sarily be  medical  graduates;  but  in  this  connection  this 
field  deserves  consideration  because  it  may  prove  invit- 
ing to  those  medical  graduates  who  find,  after  having 
made  their  preparation,  that  they  have  such  a  repug- 
nance to  morbid  humanity  that  their  success  in  gen- 
eral practice  would  be  problematical.  Moreover  it  re- 
quires for  patient  laboratory  work  just  the  careful  de- 
liberate type  of  mind  which  some  of  those  possess  who 
shrink  from  those  situations  which  require  ready  re- 
sourcefulness. 

As  set  forth  in  a  previous  chapter,  the  state  and 
municipal  departments  of  health  have  their  own  labo- 
ratories. The  hospitals  likewise  have  their  own  force 
of  laboratory  assistants.  There  are  also  research  labo- 
ratories and  the  commercial  establishments  in  which 
medical  supplies  are  prepared  and  tested;  and  in  some 

112 


Laboratory  Work.  113 

cities  specialists  establish  themselves  by  doing  work  for 
the  private  physicians. 

Examinations  of  blood  are  to  be  made  to  determine 
the  presence  of  evidence  of  typhoid  fever  or  malaria; 
mucus  from  the  throat  for  germs  of  diphtheria ;  sputum 
for  tuberculosis;  spinal  cords  of  animals  for  rabies; 
drinking  water  for  evidence  of  pollution;  drugs  for 
adulterations;  tainted  food  supplies;  and  so  on  through 
an  almost  endless  series.  The  water  supply  companies 
have  their  own  establishments  in  which  samples  of 
drinking  water  are  being  continually  tested;  and  on 
account  of  the  heavy  penalties  which  are  imposed  upon 
the  vendors  of  impure  milk,  the  milk  companies  in  our 
cities  are  compelled  to  employ  specialists  for  examining 
their  supplies. 

This  field  is  particularly  inviting  to  the  scientifically 
trained  women ;  the  associations  are  good,  the  surround- 
ings attractive,  and  the  pay  compares  favorably  with 
the  earnings  in  those  fields  usually  entered  by  women. 

Each  one  of  the  lines  of  special  laboratory  work  has 
its  own  methods  of  procedure,  and  the  routine  of  dif- 
ferent laboratories  doing  the  same  kinds  of  work  may 
vary  greatly. 

The  Bureaus  of  Standards  of  several  cities  in  which 
the  subject  of  salaries  has  been  carefully  considered 
have  recommended  schedules  of  pay  for  this  service  as 
follows:  laboratory  assistants,  in  New  York,  from  $600 
with  annual  increases  of  $120  to  $1,200;  in  Chicago, 
from  $780  with  annual  increments  of  $60  to  $960;  in 
St.  Paul,  $600  with  annual  increases  of  $60  to  $720; 
in  Portland,  Ore.,  from  $780  to  $1,200;  for  assistant 
bacteriologists,  in  New  York,  from  $1,300  to  $2,100; 
in  Chicago,  from  $1,200  to  $1,440;  for  bacteriologists, 


114  Medicine  as  a  Profession". 

in  New  York,  from  $2,280  to  $3,420 ;  in  Chicago,  from 
$1,620  to  $1,860;  in  Philadelphia,  from  $1,000  to 
$2,000;  in  Cleveland,  from  $1,200  to  $2,000;  in  Buffalo, 
from  $2,000  to  $2,300. 

Candidates  are  usually  selected  from  the  civil-service 
lists,  and  men  and  women  are  admitted  to  the  examina- 
tion on  the  same  terms.  It  is  true  that  many  of  the 
examinations  which  are  given  for  the  purpose  of  select- 
ing laboratory  assistants  can  be  passed  by  those  who 
have  had  a  good  high-school  course,  but  the  chances  of 
such  persons  for  promotion  will  be  very  limited.  A 
college  course  laying  stress  upon  practical  work  in 
biology  and  chemistry,  or  the  laboratory  work  of  the 
usual  medical  course,  is  generally  a  sufficient  prepara- 
tion for  admission  to  subordinate  positions  in  this  serv- 
ice. Specialization  either  in  college  or  in  laboratory 
service  is  needed  to  qualify  for  advanced  positions. 

Several  physicians  with  wide  experience  in  this  kind 
of  work,  upon  being  interviewed,  expressed  it  as  their 
opinion  that  the  precautions  are  such  that  those  who 
work  in  these  testing  laboratories  do  not  take  any 
special  risks  by  engaging  in  this  kind  of  work. 


ScHoor.  Medical  Txsi'KCI'ok  at  \\V)ki< 


i 


CHAPTER  XIX. 

Medical  Inspection"  of  Schools. 

The  movement  for  the  medical  inspection  of  school 
children  hardly  antedates  the  beginning  of  the  present 
century.  Like  all  such  movements  it  has  manifested 
itself  in  several  distinct  phases. 

There  is  the  period  of  argument.  In  this  country  the 
health  authorities  took  the  initiative.  They  argued 
that  since  contagious  diseases  are  disseminated  in 
crowded  assemblies,  the  school  should  be  inspected  regu- 
larly in  order  to  exclude  children  afflicted  with  con- 
tagious diseases. 

This  was  the  earliest  argument  used  in  favor  of 
medical  inspection,  and  it  was  a  health  measure  in  the 
interest  rather  of  the  public  than  of  the  individual. 
Epidemics  in  a  community  paralyze  all  commercial 
enterprises. 

Later  the  scope  of  the  argument  for  inspection  was 
supplemented  by  the  school  authorities  who  found  that 
many  children  in  the  public  schools  were  physically 
handicapped  in  their  studies;  and  as  the  state  assumed 
the  responsibility  to  train  the  children  mentally,  it  was 
not  unreasonable  to  assume  that  the  state  should  safe- 
guard the  children  against  unfavorable  physical  con- 
ditions. 

This  period  of  argument  was  followed  by  a  period  of 
trial,  through  which  we  have  passed.  As  a  result  we 
find  that  several  states  have  passed  mandatory  laws 
compelling  the  local  school  authorities  to  make  provi- 
sion for  doing  this  work,  and  hundreds  of  cities  are 

115 


116  Medicine  as  a  Peofession". 

gradually  building  up  medical  inspection  systems.  This 
will  mean  that  during  the  coming  twenty-five  years  a 
very  large  force  of  properly  trained  men  and  women 
will  be  required  for  this  kind  of  work  in  this  country. 
The  nature  and  scope  of  the  work  will  be  understood 
from  these  regulations,  which  have  been  promulgated 
by  the  government  of  Prussia : 

1.  School  physicians  are  to  be  appointed  to  all  the 
schools  of  all  the  communities,  large  and  small,  and 
children  without  exception  shall  be  subject  to  medical 
supervision. 

2.  Children  must  be  examined  by  the  physician  upon 
admission  to  school ;  at  least  once  during  the  school  life, 
and  be  given  a  final  examination  upon  leaving  school  on 
account  of  the  choice  of  a  profession. 

3.  Weak  and  sickly  children  are  to  be  continuously 
superintended. 

4.  The  school  physician  shall  also  have  the  oversight 
of  the  health  of  the  teachers  and  janitors,  and  he  shall 
be  the  expert  counsellor  of  the  board  of  education  in  all 
questions  of  school  hygiene ;  he  shall  have  a  vote  in  the 
board  of  education,  and  in  the  teachers'  training  school 
he  shall  be  the  instructor  in  physical  training  and  school 
hygiene. 

In  an  enterprising  school  district  in  a  western  state, 
the  school  physician  by  energetic  measures  secured  the 
immunity  of  the  children  of  a  district  from  diphtheria, 
while  at  the  same  time  an  epidemic  wrought  havoc  in 
adjoining  districts.  The  demonstration  made  it  easy 
for  the  school  boards  to  secure  the  necessary  support 
for  systematic  inspection  by  salaried  physicians.  The 
general  results  have  shown  that  the  progress  of  many 
children  in  their  school  work  is  hindered  by  minor 


Medical  Inspection  of  Schools.  117 

physical  defects  which  can  readily  be  remedied.  The 
uniform  results  of  trial  in  different  parts  of  the  country 
have  been  such  as  to  justify  the  contention  of  the  early 
advocates  of  medical  inspection,  and  the  next  step  in 
the  movement  will  be  the  organization  of  the  work 
throughout  the  country. 

In  New  York  city  it  has  been  found  that  the  force  of 
approximately  100  physicians  and  200  nurses  wiU  be 
wholly  inadequate  to  handle  the  problem.  Dr.  Cronin, 
of  that  city,  is  of  the  opinion  that  there  should  be  one 
physician  and  one  nurse  to  each  2,000  pupils.  In  many 
of  the  cities  of  the  country  some  local  physician  is  paid 
a  small  annual  salary  for  examining  the  children  of  one 
or  more  schools.  There  are  practical  reasons  why  the 
school  physician  should  be  a  full-time  salaried  official 
who  does  not  combine  private  practice  with  school  in- 
spection work.  This  plan  is  the  general  requirement 
in  the  English  cities  and  country  districts,  and  if  adopted 
in  this  country  it  will  open  a  field  which  will  call  for 
from  six  to  ten  thousand  medical  inspectors  of  schools. 

The  pay  for  service  of  this  kind  varies  greatly.  In 
New  York  city  full-time  medical  inspectors  are  paid 
salaries  ranging  from  $1,200  to  $3,000 ;  in  Philadelphia 
the  pay  is  from  $1,400  to  $2,400  with  a  chief  inspector 
at  $4,000;  in  Boston  from  $800  to  $2,850;  in  Pitts- 
burgh from  $1,200  to  $2,400.  These  schedules  will  at- 
tract young  men  at  the  beginning  of  their  medical 
careers,  but  it  is  not  likely  to  hold  them  longer  than 
for  a  few  years.  The  salary  schedule  is  more  likely  to 
prove  acceptable  to  women,  and  for  this  and  many  other 
obvious  reasons  this  field  is  sure  to  become  an  attractive 
one  to  women  graduates  from  the  recognized  medical 
colleges. 


CHAPTER  XX. 

Medical  Missions. 

The  mission  boards  or  religious  denominations  send 
medical  missionaries,  men  and  women,  to  non-Chris- 
tian countries  as  advance  guards  of  the  physicians  of 
souls.  Through  these  men,  who  minister  to  the  phys- 
ical distresses  of  benighted  people,  these  organizations 
hope  to  establish  such  confidential  relations  and  to  con- 
vey such  evidences  of  good  will,  that  the  work  of  the 
preacher  of  righteousness  may  be  made  easier  and  more 
far  reaching. 

As  compared  with  the  uncertain  results  of  the  crude 
treatment  of  unlearned  native  doctors,  the  medical  mis- 
sionary's skill  in  the  art  of  healing  is  regarded  by  the 
ignorant  and  superstitious  people  with  amazement  and 
wonder,  and  his  reputation  soon  spreads  far  and  wide; 
so  that  both  laborers  and  court  dignitaries  come  to  con- 
sult him. 

It  is  true  that  European  countries  maintain  in  their 
colonial  possessions,  in  connection  with  their  official 
establishments,  some  trained  physicians,  but  the  in- 
fluence of  these  men  is  confined  to  official  stations  and 
military  posts;  and  in  many  populous  districts  there  are 
millions  who  are  never  benefited  by  modern  scientific 
medicine  until  the  advent  of  the  medical  missionary. 

After  their  establishment  in  a  given  locality,  these 
medical  missionaries  spend  much  of  their  time  as  itin- 
erants, thus  increasing  the  area  of  their  influences.     In 

118 


Medical  Missions.  119 

these  journeys  they  are  compelled  to  work  with  very 
limited  resources  in  the  way  of  equipment  and  supplies. 
This  develops  resourcefulness ;  and,  moreover,  they  must 
be  strategists  and  diplomats  to  adjust  themselves  readily 
to  new  situations,  and  fit  into  the  customs  and  habits 
of  strange  peoples ;  consequently  this  work  is  exception- 
ally well  designed  to  develop  in  a  young  practitioner  all 
his  latent  powers,  through  the  unlimited  range  of  ex- 
perience which  it  affords.  He  must  have  self-reliance, 
for  there  are  no  opportunities  for  consultation;  he  must 
have  dauntless  courage,  because  his  very  successes  are 
likely  to  be  used  by  the  jealous  witch  doctors  to  arouse 
hostility  to  him.  "  Surely  the  strange  doctor  must  dig 
out  the  hearts  of  his  patients;  else  how  could  he  have 
such  tireless  energy,  and  how  could  he  have  such  super- 
natural vision,  if  he  did  not  feast  upon  the  eyes  of 
countless  victims  ?  '^  was  circulated  about  a  medical  mis- 
sionary in  a  remote  Chinese  village. 

In  their  home  station  these  missionaries  usually  have 
hospitals,  connected  with  which  are  trained  nurses,  by 
whose  aid  the  more  difficult  cases  are  treated. 

Even  with  the  facilities  provided  in  the  most  favored 
fields,  these  practitioners  are  compelled  to  exercise  an 
independence  and  self-reliance  unknown  to  their  fellows 
in  well-organized  communities.  Take,  for  instance,  the 
operation  for  the  removal  of  cataracts.  It  is  one  of 
the  most  delicate  operations  in  the  field  of  eye  surgery. 
The  highest  type  of  skill  is  necessary.  Experience 
alone  makes  for  skill  in  this  delicate  operation,  in  which 
the  eye  is  penetrated  from  side  to  side,  an  open  cut 
made  which  must  be  neither  too  large  nor  too  small  to 
insure  a  successful  termination;  and  there  is  no  guide 
except  the  judgment  of  the  operator  as  to  the  size  this 
9 


120  Medicine  as  a  Pkofession. 

cut  should  be.  The  time  to  operate,  the  method  of 
procedure,  and  many  other  things  that  enter  in  the  case, 
must  be  decided  by  the  judgment  of  the  operator.  The 
opportunities  in  this  field  are  rich  in  India,  Egypt, 
Siam  and  Arabia.  Thousands  of  cases  of  blindness  due 
to  cataract  are  found  in  these  countries,  and  with  the 
exception  of  the  British  government  medical  service  in 
India  and  Egypt,  the  afflicted  must  depend  upon  the 
medical  missionaries.  One  medical  missionary  in  India 
reported  over  6,000  cataract  operations. 

Today  the  most  noted  cataract  operator  in  the  world. 
Colonel  Smith,  lives  in  India.  He  has  given  to  science 
the  results  of  his  experience.  He  proves  that  by  using 
a  technic  and  method  devised  by  himself,  it  is  unneces- 
sary to  wait  until  the  so-called  "ripening"  of  the  cata- 
ract takes  place ;  but  that  the  cases  can  be  operated  upon 
at  any  time  after  the  vision  gets  dim,  thus  saving  the 
patient  in  many  instances  a  year  or  two  of  total  blind- 
ness. 

It  must  go  without  saying  that  the  appointing  bodies 
require  that  candidates  for  this  work  shall  be  conse- 
crated Christian  men  and  women,  and  also  be  fully 
versed  in  the  science  of  medicine  and  skilled  in  the  art 
of  healing. 

The  pay  of  from  $500  to  $1,500  with  professional  and 
living  expenses  compares  not  unfavorably  in  purchasing 
value  with  the  income-earning  power  of  beginners  in 
private  practice  at  home;  but  such  are  the  demands 
upon  their  sympathies  in  the  foreign  field  that  the 
purses  of  few  can  withstand  the  financial  strain. 

A  recent  census  shows  that  there  are  800  Protestant 
medical  missionaries  in  charge  of  698  hospitals  and  979 
dispensaries,  and  that  they  treated  in  1914  approxi- 


Medical  Missions.  121 

mately  10,000,000  patients.  This  manifestation  of  de- 
voted self-sacrifice,  on  the  part  of  highly  trained  men, 
as  well  as  of  the  generosity  of  those  who  provide  their 
support,  must  prove  refreshing  to  those  who  turn  with 
horror  from  the  acts  of  the  assumed  divinely  appointed 
rulers  of  European  nations,  who  have  in  that  same  year 
hurled  their  subjects  by  the  thousands  to  sure  death. 

Nor  has  this  altruism  been  without  reward  to  its 
practitioners.  Through  the  studies  of  missionaries  it 
has  been  found  that  the  sleeping  sickness  of  Africa 
could  be  controlled  by  the  extermination  of  the  fly 
which  spreads  it;  that  quinine  is  a  remedy  for  fevers; 
that  permanganate  of  potash  is  a  proper  prescription 
for  the  bite  of  the  cobra,  and  so  on  through  a  long  list. 

Dr.  Cyril  H.  Haas  in  a  small  tract  used  by  the  Stu- 
dents' Volunteer  Movements,  125  East  27th  Street,  New 
York,  gives  a  doctor's  reason  for  going  to  China : 

"  The  first  of  these  reasons  is  because  it  is  the  dictate 
of  mere  common  sense.  I  do  not  know  of  anything 
which  we  talked  more  about  in  our  senior  year  than 
where  we  were  going  to  practice.  When  I  faced  the 
last  day  of  my  senior  year,  I  met  a  man  who  told  me 
that  everything  was  congested.  I  went  into  the  city, 
but  was  advised  that  it  took  an  average  of  ten  years  for 
a  physician  to  become  self-supporting.  I  went  into  the 
country,  and  physicians  told  me  that  I  could  do  no 
surgery,  because  if  I  attempted  it  I  was  liable  to  make 
mistakes  and  my  reputation  would  be  gone.  Where 
was  a  man  going  to  practice  ?  I  saw  in  the  Journal  of 
the  American  Medical  Association  that  we  were  pouring 
out  of  our  medical  colleges  4,000  young  men  every  year, 
and  that  we  only  needed  a  possible  3,000  to  fill  the 
vacancies  left  by  those  who  died.     I  saw  that  the  Com- 


122  Medicine  as  a  Peofession". 

mittee  on  Medical  Education  in  this  country  was  seri- 
ously considering  the  printing  of  pamphlets  to  send  to 
high-school  boys,  urging  them  not  to  enter  the  medical 
profession,  because  the  great  influx  of  students  made  it 
impossible  for  them  to  find  room  in  the  profession  in 
this  country.  I  think  that  it  is  nothing  more  than 
common  sense  for  a  young  physician,  at  least  if  he  is  a 
Christian,  to  look  to  some  other  country  than  this  for 
practice. 

"The  second  factor  that  urges  me  to  go  to  another 
land  is  common  duty.  I  have  many  times  seen  a  vision 
of  a  city  of  150,000  people  in  the  center  of  Asia,  outside 
of  which  there  is  a  little  hill,  and  upon  that  hill  there 
are  now  going  up  two  buildings,  one  to  be  the  hospital 
for  women  and  the  other  for  men;  and  from  that  city 
has  come  many  times  within  the  last  few  years  the 
urgent  plea  that  I  go  out  there  and  be  one  of  the  phy- 
sicians in  that  city  where  they  know  nothing  of  hygiene, 
nothing  of  surgery,  nothing  of  asepsis,  nothing  of  the 
great  remedies  which  we  have  to  alleviate  pain ;  nothing 
but  squalor,  sin,  weakness,  sickness,  uncleanliness. 
Nothing  but  common  duty  urges  me  to  go  out  there. 

"And  the  third  reason  why  I  go  is  because  of  the 
unique,  unmeasured  privilege.  The  grandest  moment 
in  my  life  will  be  when  I  stand  with  my  colleagues  on 
that  hospital  ground  and  the  gates  are  flung  open  with 
the  news  that  the  hospital  is  completed,  and  the  invita- 
tion goes  out  to  that  city :  ^  Come  in.'  I  met,  some  time 
ago,  a  Chinese  who  told  me  of  the  necessity  of  having  a 
Chinese  name,  and  I  said,  'Would  you  christen  me?' 
He  wrote  out  a  name  in  Chinese  and  I  said,  '  What  does 
it  mean?'  He  replied  with  this  translation  of  it, 
'  American  physician,  willing  to  help.'    I  hope  to  go  out 


Medical  Missions.  123 

some  day  as  Chen-chou  Fu  and  be  an  American  physi- 
cian willing  to  help.  I  hope  to  see  some  day,  under  the 
touch  of  the  knife,  in  the  dispensary,  at  the  bedside, 
the  play  of  the  masterful  forces  of  Jesus  Christ,  as 
through  sympathy  and  tenderness  and  unselfish  service, 
his  own  life  may  strike  deep  into  the  lives  of  these  who 
know  him  not.  God  is  going  up  and  down  in  this  great 
concourse  of  students,  laying  his  hand  upon  man  after 
man,  medical  student  after  medical  student,  calling  him 
to  be  great  enough  and  big  enough  and  loyal  enough  to 
go  out  into  this  staggering,  sorrowing,  struggling  world 
and  be  to  it  what  Christ  was,  to  pity  it  as  Christ  pitied 
it,  to  love  it  as  Christ  loved  it,  and  to  serve  it  with  his 
own  sacrificial  heart.  God  calls  vsdth  loving  patience 
for  men  to  lay  their  lives  alongside  of  the  tremendous 
immeasurable  needs  of  the  non-Christian  countries,  and 
to  solve  the  awful  problem  of  human  suffering;  and  as 
I  shall  set  sail  in  a  little  while  for  that  great  Empire  of 
China,  I  want  to  carry  with  me  from  this  hour  the  con- 
viction that  the  men  here  are  going  to  enter  into  a 
solemn  compact  with  me  to  devote  their  lives,  especially 
the  medical  students,  to  the  solving  of  the  problem  of 
human  suffering  in  the  non-Christian  world.^^ 

The  members  of  the  Catholic  brotherhoods  and  sister- 
hoods also  support  movements  of  this  kind  in  all  parts 
of  the  world. 


124 


Medicine  as  a  Profession". 


Medical  Missionaries  of  Protestant  Churches. 


Men. 

Wo- 
men. 

Hos- 
pitals. 

Dis- 
pen- 
saries. 

Countries. 

Seventh    Day    Ad- 
ventist 

American  Baptist ... 

Seventh  Day  Bap- 
tist  

17 

55 

12 

25 

16 

3 
3 

9 

3 

40 

102 

14 

13 
2 

7 
18 

2 
2 

12 
4 

5 
5 

41 
38 

7 
1 

4 
19 

6 

28 

5 

25 

1 

2 

6 

1 
45 

80 

7 
13 

8 

33 

1 
13 

40 

7 

2 
2 

15 

3 
36 

119 

11 

9 

7 

Africa,  Asia,  South 
America. 

Philippines,  Congo, 
Burma^  China,  South 
India,  Assam,  Bengal. 

China,  India,  Africa. 

Southern  Baptist.... 

American  Board 

Christian  Women's 
Board 

China,  Japan,  Africa, 
Mexico,  South  Amer- 
ica. 

Africa,  India,  China, 
Philippines,  Turkey, 
Japan,  Ceylon. 

Africa,  India,  West 

Foreign     Christian 
Missionary  Society 

Evangelical 

Indies,  Mexico,  New 
Zealand. 

China,     Tibet,     Philip- 
pines, Africa,  Japan. 

China,  Japan. 

Alaska,  India,  Mexico, 
China,  Africa. 

India,  Japan,  China, 
Africa,  Madagascar. 

India. 

American  Friends... 
Lutheran 

nites 

Methodist 

China,  India,  Japan, 
Korea,  Africa,  Philip- 
pines. 

India,    Mexico,    Sudan, 

Presbyterian 

Protestant    Episco- 
nal 

China,  Persia,   Siam, 
Japan,      Philippines, 
Africa,  Korea,  Cuba, 
Syria,  Brazil,  Cyprus, 
Asia  Minor. 

Africa,    China,    Japan, 

Cuba,  Brazil. 
Japan,  China,  India. 
China,  Japan,  Africa. 

Reformed  Church... 
United  Brethren 

CHAPTER  XXI. 

COEPOEATION  SeKVICE. 

Railway  Service. 

Every  one  of  the  railway  organizations  has  its  own 
surgical  staff,  consisting  of  a  chief  surgeon  and  local 
assistant  snrgeons. 

The  chief  surgeon's  duties  are  to  pass  upon  all  ex- 
aminations of  employees  wishing  to  enter  the  railway 
service;  to  direct  the  sanitation  of  the  road,  disinfect 
coaches,  supervise  the  drinking  water  supply,  to  appoint 
and  dismiss  local  assistant  surgeons,  and  see  to  the  effi- 
ciency of  the  medical  service  of  the  road.  He  passes 
upon  the  applications  for  pension  of  disabled  employees, 
he  assists  or  advises  the  legal  department  in  all  cases  of 
a  medico-legal  aspect,  such  as  damage  suits  for  injuries 
sustained  by  employees,  or  others,  on  the  railroad  prop- 
erty. This  latter  function  is  a  very  important  one,  as 
thousands  of  claims  for  damages  are  filed  against  rail- 
road corporations  by  persons  whose  claims  are  based 
upon  injuries  received  on  railroad  property.  The  chief 
surgeon  in  these  cases  must  have  physical  examinations 
made  of  the  victim,  in  order  to  determine  the  extent  of 
permanent  disability  and  to  be  able  to  advise  the  legal 
department. 

The  chief  surgeon  directs  the  treatment  of  cases  of 
injury,  he  instructs  the  local  surgeons  how  to  proceed  in 
emergency  work,  and  in  rendering  first  aid.     One  must 

125 


126  Medicine  as  a  Profession". 

remember  that  these  railroad  surgeons  do  not  only 
render  first  aid  to  the  injured  employees  of  the  system, 
but  also  to  those  of  the  traveling  public  who  receive 
injury  in  railroad  accidents. 

On  one  of  the  western  railroad  systems  there  is  a 
hospital  system  organized  jointly  by  the  corporation 
and  employees.  It  is  very  necessary  where  there  are 
great  distances  between  large  cities.  The  railway  com- 
pany pays  for  the  care  of  the  injured,  and  for  the  em- 
ployees by  assessments;  in  this  way  sufficient  hospital 
facilities  are  maintained  in  sparsely  settled  communi- 
ties, providing  competent  medical  service  for  employees 
and  the  traveling  public. 

The  salaries  of  the  chief  surgeons  run  from  $2,500 
to  $6,000,  depending  somewhat  upon  the  amount  of 
work,  and  whether  part  or  whole  time  is  taken  up  by 
official  duties. 

The  local  railway  surgeons  who  are  stationed  at  all 
important  points,  one  or  more  in  practically  every 
county,  are  on  the  fee-bill  basis,  and  receive  payment 
according  to  the  rates  prevailing  in  their  locality. 
Others  in  division  points  are  on  a  straight  salary,  sub- 
ject to  call  of  the  local  railway  officials.  In  nearly  all 
cases  the  local  surgeon  gets  free  transportation  for  him- 
self and  family,  over  the  lines  of  the  company;  and 
some  companies  extend  this,  upon  special  application, 
to  foreign  roads. 

The  duties  of  the  local  surgeons  are  outlined  in  the 
general  instructions,  and  if  the  case  demands  special  in- 
structions, these  are  given  by  the  chief  or  division 
surgeon. 

The  railway  service  should  not  be  considered  as  a  field 
in  itself  offering  sufficient  remuneration  for  a  young 


Corporation  Service.  127 

man,  because  no  young  man  can  obtain  the  appoint- 
ment as  chief  surgeon.  A  chief  surgeon  must  be  an 
older,  experienced,  responsible  man.  The  local  appoint- 
ments, with  few  exceptions,  do  not  pay  enough  for  full- 
time  work.  The  work  is  ideal,  though,  as  a  side  line  to 
a  general  practice.  Many  opportunities  arise  for  one 
to  demonstrate  his  skill  and  aptitude  in  surgery.  This 
work  will,  besides  offering  good  experience  with  small 
compensation,  help  him  to  establish  himself  in  private 
work.  The  very  fact  that  one  is  employed  by  the  rail- 
way corporation  as  a  surgeon  gives  him  prestige. 

Transatlantic  steamships  also  have  medical  men  on 
their  regular  staffs.  These  positions  are  not  unlike 
the  positions  which  are  offered  by  hospitals  to  young 
graduates  of  medical  colleges.  The  men  receive,  in  ad- 
dition to  their  maintenance,  small  salaries. 

The  life-insurance  business  has  developed  by  leaps 
and  bounds  within  the  last  twenty  years,  and  all  com- 
panies must  depend  upon  physicians  for  the  examina- 
tion of  their  risks.  In  each  community  where  a  life- 
insurance  company  does  business,  it  has  a  medical  ex- 
aminer. Each  company  employs  its  own,  and  in  some 
communities  nearly  all  physicians  are  examiners  for 
one  or  more  insurance  companies.  Other  communities 
have  one  or  two  physicians  who  do  all  the  examining. 

These  appointments  in  themselves  are  not  sufficiently 
remunerative  to  be  depended  on  for  an  income,  but  they 
give  one  prestige  and  an  opportunity  for  acquaintance 
that  helps  in  building  up  a  private  practice. 

Then  there  are  examinations  to  be  made  for  the  fra- 
ternal insurance  associations,  as  for  the  Modern  Wood- 
men, The  Foresters,  The  Eed  Men,  The  Knights  of 


128  Medicine  as  a  Profession". 

Pythias,  etc.  These  examinations  are  usually  made  by 
physicians  who  are  members  of  the  orders. 

The  fees  for  old-line  life-insurance  examination  are 
from  $3  to  $5 ;  for  fraternal  or  assessment  orders,  from 
$1  to  $2. 

The  passage  of  workingmen's  compensation  laws, 
under  which  employers  are  compelled  to  pay  directly 
or  indirectly  for  the  accident  insurance  risks  of  their 
working  men,  makes  it  necessary  for  practically  all 
manufacturing  corporations  to  retain  the  service  of  a 
physician,  who  serves  them  much  in  the  same  way  as 
the  doctors  serve  the  railroads. 

Many  large  corporations  employ  physicians  on  full 
time,  and  this  opens  a  field  which  young  men  may  well 
consider.  It  must  be  remembered  that  there  are  many 
commercial  organizations  and  industrial  concerns  which 
employ  a  thousand  or  more  people  whose  efficiency  is 
determined  by  their  physical  condition.  The  managers 
of  these  corporations  are  organizing  medical  depart- 
ments for  the  service  not  only  of  the  employees,  but  also 
of  their  families  very  much  after  the  plans  of  the  med- 
ical departments  of  the  army  posts.  This  field  should 
prove  attractive  to  the  young  medical  graduate.  For 
winning  the  highest  success  he  should  be  informed  on 
the  methods  of  welfare  work  in  all  of  its  various  aims. 


CHAPTEK  XXII. 

The  Eed  Cross. 

It  was  Jean  Henri  Dunant  who  after  witnessing  the 
apparently  iinnecessary  suffering  of  the  wounded  on  the 
battle  field  made  such  an  effective  appeal  as  to  lead  to 
the  organization  of  an  international  association  for  re- 
lief with  branches  in  all  civilized  countries.  The  banner 
of  the  organization  was  a  red  cross  on  a  white  field.  In 
1881  the  American  Eed  Cross  was  organized  with  Miss 
Clara  Barton  as  its  president.  For  twenty-four  years 
the  organization  has  held  itself  in  readiness  to  assist  in 
relief  measures  in  every  kind  of  calamity,  whether  war, 
or  fire,  or  flood,  earthquake  or  epidemic.  In  1905  a 
reorganization  was  effected  and  governmental  support 
was  accorded  to  the  American  society.  Its  activities 
are  carried  on  through  many  subdivisions  of  the  associa- 
tion. We  are  here  concerned  only  with  the  medical  serv- 
ice. This  service  supplements  the  work  of  the  army 
medical  service  and  the  federal  health  service. 

The  Eed  Cross  base  hospital  unit  is  composed  of  22 
physicians,  2  dentists,  50  nurses,  25  volunteer  nurses' 
aids,  and  15  civil  employes.  The  base  hospitals  are 
under  the  direction  of  some  parent  institution,  that  is 
the  staff  officers  of  some  hospital  who  select  the  physi- 
cians and  nurses  for  this  work.  During  times  of  peace 
there  is  no  remuneration  to  the  members  of  these  units, 
but  during  times  of  war  they  are  mustered  into  service 
and  given  commissions  and  pay  according  to  their  re- 

129 


130  Medicine  as  a  Peofession". 

spective  positions,  as  colonels,  majors,  captains  or  lieu- 
tenants. Three  months  after  the  country  entered  the 
European  war  forty-one  of  these  base  hospitals  were 
organized  and  ready  for  service.  It  costs  about  $75,000 
to  equip  one  of  these  hospitals.  The  experience  which 
— H:hese  base  hospitals  afford  is  not  unlike  that  which  is 
obtained  in  the  army  medical  service  but  those  engaged 
in  the  Eed  Cross  work  are  not  exposed  to  the  hazards 
of  those  in  service  on  the  front  battle  lines.  The  hos- 
pitals are  usually  located  in  the  rear  of  the  fighting  lines. 
The  buildings  are  of  more  or  less  permanent  kind  and 
the  quarters  of  the  officers  are  usually  comfortable. 
When  these  units  are  mustered  into  military  service,  all 
of  the  officers,  of  course,  come  under  military  discipline. 
From  the  officers  in  these  base  hospitals  special  teams 
are  organized  for  emergency  service  in  the  field. 

Mnety  days  after  diplomatic  relations  with  Germany 
were  severed,  forty-two  ambulance  companies  were  or- 
ganized by  the  Eed  Cross  for  service  in  the  field  and  the 
number  of  these  organizations  is  being  ext-ended  as  rap- 
idly as  funds  become  available.  These  ambulance  units 
form  relief  divisions  ready  for  emergency  service  on  the 
firing  line  or  in  the  thickest  of  the  battle  to  render  first 
aid  service  to  the  injured.  Each  unit  is  composed  of  a 
director,  three  surgeons,  one  head  nurse,  six  assistants 
and  a  clerk.  These  units  are  expected  to  respond  to  any 
emergency  calls  and  their  work  is  most  hazardous  and 
strenuous.  No  more  brilliant  exploits  of  daring  are 
recorded  in  history  than  those  which  have  been  per- 
formed by  the  Red  Cross  ambulance  corps  in  our  recent 
wars. 

It  is  true  that  by  the  Geneva  Convention  all  the 
signatory  powers  agreed  that  in  times  of  war  the  work 


The  Eed  Cross.  131 

of  the  Eed  Cross  should  be  accorded  full  protection  by 
the  armies  of  belligerents  but  with  the  introduction  of 
long  range  guns  it  is  practically  impossible  for  the  artil- 
lery men  to  distinguish  between  those  who  are  perform- 
ing these  missions  of  mercy  and  their  enemies  and  these 
guarantees  of  protections  come  to  mean  less  and  less. 
The  expenditures  for  service  in  European  battle-fields 
for  1917  will  exceed  ten  millions  for  the  American  Red 
Cross  alone. 

The  permanent  office  of  the  American  Eed  Cross  at 
Washington  is  rendering  a  great  national  service  in  hav- 
ing its  enrolled  lists  of  men  who  are  ready  to  undertake 
any  kind  of  emergency  service  which  may  be  called  for 
by  any  great  calamity.  Upon  short  notice  they  were 
able  to  have  ready  for  service  in  times  of  such  great 
floods  as  swept  through  the  Miami  Valley  and  the  de- 
struction of  San  Francisco  their  enrolled  volunteers 
from  near  by  localities. 


CHAPTER  XXIII. 

Eeseakch  Woek. 

Dr.  Eobert  T.  Morris  has  recently  expressed  the  opin- 
ion that  the  future  advances  in  medicine  will  be  made 
by  the  men  who  work  on  salaries  and  give  their  undi- 
vided time  and  energy  to  investigation;  that  so  many 
factors  are  involved  in  physiological  processes,  the 
process  of  elimination  is  so  slow,  and  the  continual, 
patient,  watchful  attention  so  necessary,  that  only  the 
man  who  devotes  his  whole  energy  and  time  to  a  sub- 
ject can  hope  to  master  the  field  of  related  knowledge 
sufficiently  well  to  extend  our  conquests  into  disputed 
or  little-known  areas. 

This  has  recently  been  recognized,  in  the  wide  accept- 
ance of  the  recommendations  of  medical  councils  that 
the  professors  in  medical  colleges  should  be  paid  salaries 
sufficiently  large  so  that  it  would  not  be  necessary  for 
them  to  combine  teaching  and  practice;  that  the  de- 
mands of  their  professorial  duties  should  be  so  limited 
that  they  could  command  the  time  for  study  in  their 
several  special  fields ;  and  that  the  laboratory  and  library 
equipments  of  the  acceptable  medical  college  should  be 
increased  far  beyond  what  is  found  at  present  in  the 
average  institution. 

The  necessity  for  setting  aside  certain  men  to  give 
their  time  to  the  investigation  of  special  problems  has 
also  been  recognized  in  the  public  health  service  and  by 
the  establishment  of  the  Eockefeller  Institute  at  Sixty- 

132 


Eesearch  Work.  133 

sixth  St.  and  Avenue  A,  in  New  York  city,  which,  with 
its  munificent  endowment  of  $4,000,000,  is  exclusively 
devoted  to  medical  research. 

Progress  has  at  best  been  slow  when  made  by  men 
burdened  with  regular  daily  tasks,  using  their  odd 
hours,  working  in  poorly  equipped  laboratories,  with  an 
inadequate  command  of  the  existing  field  of  knowledge 
in  the  departments  in  which  they  were  experimenting. 

In  previous  chapters,  reference  has  been  made  to  the 
investigation  into  the  causes  of  yellow  fever  and  other 
destructive  scourges.  Physicians  daily  meet  with 
equally  destructive  influences,  of  whose  control  they  are 
ignorant. 

Of  late  years,  the  disease  known  as  infantile  paralysis 
has  become  epidemic  in  various  parts  of  the  country; 
even  adults  have  developed  the  disease  in  fatal  forms. 
Many  who  have  recovered  are  partially  paralyzed,  some 
permanently.  The  medical  fraternity  has  been  aroused ; 
men  are  seeking  for  the  causes  of  the  disease,  for  the 
mode  of  its  dissemination,  and  the  possible  methods  of 
control. 

In  1909,  Landsteiner  and  Popper  produced  the  disease 
in  monkeys  by  inoculation,  thus  proving  that  the  disease 
could  be  communicated.  Dr.  Flexner  of  the  Eockefeller 
Institute  proved  that  it  could  be  transmitted  from 
monkey  to  monkey,  showing  that  it  was  due  to  an 
organism  that  could  not  only  be  developed  in  a  living 
being  but  transplanted  from  one  to  another.  While  the 
infectious  material  could  not  be  isolated,  it  was  found 
that  it  could  be  transmitted;  that  some  animals  were 
immune  to  it.  There  is  a  call  for  some  devoted  soul 
to  expose  himself  while  he  engages  in  the  search  for  the 


134  Medicine  as  a  Profession". 

disturbing  cause  and  if  he  succeeds  to  enroll  his  name 
on  the  world's  list  of  immortals. 

Dr.  Alexis  Carrell,  of  the  Eockefeller  Institute,  re- 
ceived the  Nobel  prize  for  his  discovery  that  blood  ves- 
sels could  be  transplanted  and  sutured,  that  sections  of 
veins  could  be  inserted  into  arteries,  that  they  will  heal 
and  function  in  spite  of  the  fact  that  the  arterial  coats 
are  much  stronger  and  firmer  than  those  of  the  veins. 
He  demonstrated  the  practical  value  of  his  discovery  by 
joining  the  radial  artery  of  a  father's  arm  to  the  vein 
of  a  five  day  old  child,  thus  saving  the  life  of  the  latter 
through  a  transfusion  of  blood. 

By  this  discovery  the  old  and  cumbersome  methods 
of  transfusion  of  blood  were  displaced.  Before  these 
successful  experiments,  preceded  by  a  long  series  on 
lower  animals,  no  surgeon  would  have  sutured  these 
blood  vessels  together,  because  of  the  possible  fatal  in- 
troduction of  blood  clots  into  the  circulation. 

The  wonderful  possibilities  suggested  by  the  experi- 
ments of  Professor  Metchnikof,  in  proving  that  many  of 
the  fatal  poisons  which  shorten  human  life  are  generated 
in  the  body  by  the  action  of  bacteria  which  can  be  de- 
stroyed through  the  introduction  of  other  bacteria,  have 
opened  up  a  new  and  very  fascinating  field  of  experi- 
ment, through  the  mastery  of  which  competent  authori- 
ties have  predicted  that  human  life  can  be  indefinitely 
prolonged. 

Just  enough  is  at  present  known  about  biochemistry 
to  suggest  the  possibility  of  the  accurate  regulation  and 
control  of  the  chemical  composition  of  fluids  of  the 
body,  in  such  a  way  that  methods  may  be  devised  as 
revolutionary  as  those  which  have  followed  the  discovery 
of  the  properties  of  radium  and  the  X-ray. 


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Eesearch  Work.  135 

The  progress  in  physics  has  suggested  the  possibility 
of  saving  by  cold  storage  processes  the  healthy  organs  of 
persons  who  have  met  violent  deaths,  for  transplanting 
in  place  of  diseased  organs  in  living  persons. 

In  the  field  of  sanitation,  it  has  been  proved  that,  at 
an  expense  of  less  than  $3  per  year  per  inhabitant,  it  is 
possible  to  make  the  miasmatic  regions  of  the  Canal 
Zone  as  safe  as  the  most  carefully  guarded  city ;  and  since 
the  methods  for  doing  this  work  have  been  so  worked 
out  that  they  may  be  adapted  to  any  locality,  one  ceases 
to  wonder  why  liberal  men  should  be  ready  to  give  large 
means,  and  why  men  of  strong  intellects  should  be  at- 
tracted to  the  narrow  confines  of  the  laboratory,  to  de- 
vote promising  lives  to  patient  study  and  investigation. 
It  is  needless  to  say  that  those  who  are  selected  to  do 
this  work  must  be  men  of  demonstrated  intellectual 
ability  with  a  capacity  for  work,  and  with  such  a  devo- 
tion to  humanity  that  they  will  find  their  reward  in 
their  work,  rather  than  in  the  monetary  returns  which 
these  positions  pay.  One  of  these  will  discover  the  real 
cause  of  cancer,  and  develop  a  cure  for  it;  another  will 
place  himself  alongside  of  Jenner  by  leading  the  world 
to  a  mastery  of  tuberculosis ;  and  through  the  labors  of 
others,  one  after  another  of  the  enemies  of  humanity 
which  have  heretofore  baffled  science  will  be  controlled. 


10 


CHAPTEE  XXIV. 

Commerce  and  Medicine. 

Closely  related  to  the  work  of  the  research  men  in 
medicine  is  the  work  of  the  preparation  and  distribu- 
tion of  the  curative  and  remedial  agents,  whose  virtues 
have  been  discovered  in  the  research  laboratories  and 
tried  out  in  the  dispensaries  and  the  hospitals,  and  the 
manufacture  and  sale  of  medical  supplies.  After  Jen- 
ner  had  discovered  his  treatment  for  smallpox,  through 
the  careless  handling  of  vaccine  the  treatment  was  used 
with  only  partial  success,  thus  arousing  prejudice  against 
it  and  hindering  its  use  for  many  years.  This  has  been 
changed,  and  the  laboratories  which  supply  vaccines, 
antitoxins,  bacterins  and  tuberculins  are  now  supervised 
by  trained  experts. 

Not  less  than  forty  biological  products  are  used  in 
medicine  today,  and  each  is  prepared  according  to  its 
own  special  methods.  The  important  factor  in  the 
preparation  of  these  products  is  the  maintenance  of 
absolute  purity  and  standard  of  immunizing  power,  so 
that  the  physician  may  inoculate  the  patient  without 
any  danger  of  implanting  in  him  the  germs  of  some 
other  disease. 

There  are  in  this  country  today  twenty-five  of  these 
commercial  biological  laboratories,  all  of  which  are  regu- 
larly inspected  by  officers  of  the  federal  goverimient. 

In  the  preparation  of  the  antitoxin  for  diphtheria, 
young  healthy  horses  are  rendered  immune  to  the  poison. 
The  toxin  is  obtained  by  the  development  of  a  virulent 

136 


Commerce  and  Medicine.  137 

culture  of  the  diphtheria  bacilli  "upon  the  surface  of  beef 
bouillon  in  a  flask  at  a  uniform  temperature  of  65  de- 
grees Fahr.  for  one  week.  The  culture  is  then  treated 
with  a  5  per  cent,  solution  of  carbolic  acid,  and  after 
standing  for  forty-eight  hours  the  solution  is  filtered. 
A  one-hundredth  cubic  centimeter  is  then  injected  into 
a  250-gram  guinea  pig,  and  if  it  kills  the  animal  within 
four  days  it  is  considered  strong  enough  to  try  on  the 
horse.  The  horse  is  given  an  amount  of  the  toxin  which 
would  be  considered  necessary  to  kill  5,000  guinea  pigs 
of  the  former  weight.  At  the  same  time  he  also  re- 
ceives an  injection  of  10,000  units  of  diphtheria  anti- 
toxin. This  process  is  repeated  with  larger  doses  of  the 
poison,  and  in  three  or  four  days  a  repetition  of  the 
doses  of  both  the  toxin  and  the  antitoxin.  After  this 
the  animal  receives,  every  five  days,  an  injection  of  the 
toxin  only,  and  so  the  conflict  between  the  virulent 
germs  and  their  enemies  is  waged  in  the  circulatory  sys- 
tem of  the  animal  for  about  six  weeks;  after  which  a 
little  blood  serum  is  withdrawn  and  its  resisting  power 
is  tested.  If  its  power  is  high  the  horse  is  bled  to  death 
under  strict  conditions  of  cleanliness,  the  blood  serum  is 
concentrated,  refined,  standardized  and  put  into  care- 
fully sealed  packages  for  the  market. 

It  is  needless  to  say  that  great  care  must  be  exercised 
to  see  that  the  animals  are  sound  and  healthy,  that  the 
stables  and  surroundings  are  sanitary  and  that  the  labo- 
ratories and  appliances  and  all  the  attendants  are  clean 
according  to  the  scientific  definitions  of  cleanliness. 

Many  men  who  find,  after  completing  their  medical 
course,  that  they  are  lacking  in  some  of  the  qualities 
which  are  needful  for  success  in  practice,  and  that  they 
do  not  possess  the  imagination  nor  the  initiative  for 


138    •  Medicine  as  a  Profession. 

success  in  independent  research,  may  find  profitable 
uses  for  their  training  in  this  interesting  and  highly 
important  work.  The  workers  in  this  field  are  not 
called  upon  to  submit  to  the  irregular  demands  which 
are  made  upon  the  time  and  the  energies  of  a  practi- 
tioner, yet  the  work  is  not  without  its  dangers  of  infec- 
tion while  handling  various  kinds  of  bacteria.  The 
salaries  range  from  $1,000  to  $2,500. 

The  superintendentsi  of  the  laboratories  which  pre- 
pare for  the  trade  the  pills,  powders  and  tinctures  in 
endless  forms  and  varieties  are  rather  pharmacists  and 
chemists  than  physicians,  and  the  manufacturers  of 
surgical  appliances  and  supplies  are  for  the  most  part 
men  who  have  had  a  training  for  business  rather  than 
for  a  profession;  but  many  men  of  medical  education 
are  employed  as  salesmen  to  introduce,  among  physi- 
cians, these  commercial  products. 

Not  a  few  physicians  in  the  past,  not  content  with 
the  slow  returns  from  an  ethical  practice,  have  thrown 
their  ethical  codes  to  the  winds  and  embarked  upon  the 
manufacture  and  sales  of  so  called  patent  medicines. 
In  one  of  our  cities  this  business  has  developed  to  large 
proportions  and,  according  to  the  reports  made  to  the 
commercial  bureaus,  the  managers  of  the  houses  in  this 
line  of  business,  after  deducting  their  raw  materials, 
salaries  and  wages  and  other  expenses  from  the  factory 
value  of  their  manufactured  product,  had  left,  in  1909, 
198  per  cent,  on  their  capital  invested.  In  recent  years, 
on  account  of  the  rigid  supervision,  and  the  refusal  of 
their  advertisements  by  newspapers,  there  has  been  some 
decline  in  this  business.  In  few  of  these  concerns  which 
were  examined  did  any  of  the  employees  receive  more 
than  a  living  salary.     It  is  a  mistake  for  one  com- 


O 


O 

z 


o 


Com:merce  and  Medicine.  139 

mercially  inclined  to  enter  medicine  with  the  desire  to 
"  get-rich-quick  "  through  quackery.  There  are  so  many 
respectable  commercial  enterprises  that  should  appeal 
to  such,  rather  than  this  questionable  trafficking  in 
human  lives. 

Biological  Laboratories. 

The  following  biological  laboratories  were  licensed 
(1916)  by  the  Treasury  Department  of  the  federal  gov- 
ernment to  manufacture  vaccines,  serums,  toxins,  anti- 
toxins, bacterins,  etc.:  The  Cutter  Laboratories,  Berke- 
ley, California;  Hygienic  Laboratories,  State  Board  of 
Health,  California;  American  Biological  Co.,  Washing- 
ton, D.  C. ;  National  Vaccine  and  Antitoxin  Institute, 
Washington,  D.  C;  Memorial  Institute,  Chicago;  The 
Abbott  Laboratories,  Abbott  Alkaloidal  Co.,  Chicago; 
Eli  Lilly  &  Co.,  Indianapolis ;  Swan  Myers  Co.,  Indian- 
apolis; Dr.  W.  T.  McDougall,  Kansas  City,  Kansas; 
Greeley  Laboratories,  Boston ;  Stafford  Biological  Labo- 
ratories, Detroit;  Dr.  G-.  H.  Sherman,  Detroit;  Parke, 
Davis  &  Co.,  Detroit;  The  Upjohn  Co.,  Kalamazoo, 
Michigan;  St.  Louis  Pasteur  Institute,  St.  Louis,  Mis- 
souri; Laboratory  of  Clinical  Pathology,  Kansas  City, 
Missouri;  Bactero-Therapeutic  Laboratories,  Asheville, 
North  Carolina;  E.  K.  Squibbs  &  Sons,  Eesearch  & 
Biological  Laboratories,  New  Brunswick,  New  Jersey; 
New  York  Pasteur  Institute,  New  York  City;  Lederle 
Antitoxin  Laboratories,  Pearl  Eiver,  New  York;  Labo- 
ratories of  Dept.  of  Health,  New  York  City ;  Dr.  James 
McI.  Phillips,  Columbus,  Ohio;  Dr.  H.  M.  Alexander 
&  Co.,  Marietta,  Pennsylvania;  H.  K.  Mulford  Co., 
Philadelphia,  Pa.;  The  Slee  Laboratories,  Swiftwater, 
Pa. 


CHAPTEK  XXV. 

Specialism. 

One  often  hears  the  school  boy  say  that  he  is  going  to 
be  an  expert  surgeon  in  response  to  the  question  as  to 
what  he  intends  to  make  of  himself.  This  is  really  a 
commendable  ambition,  but  little  does  the  average  boy 
realize  what  it  takes  to  make  his  dream  come  true.  To 
be  an  expert  in  any  of  the  special  fields  of  medicine 
means  years  of  work  of  preparation  and  practice.  The 
impression  prevails  among  many  prospective  students 
that  the  only  requirement  to  become  a  specialist  is  to 
comply  with  the  accepted  curriculum  of  a  regular  med- 
ical college,  and  subsequently  to  add  a  postgraduate 
year  in  the  specialty  desired.  This  impression  is  erro- 
neous. To  become  a  specialist  in  medicine  one  must 
have  a  wide  experience  in  a  general  practice  of  medicine. 
He  must  have  a  grasp  of  the  whole  category  of  disease, 
and  the  effect  of  disease  on  the  whole  body  of  man,  be- 
fore he  is  able  to  analyze  in  detail  the  cause  of  disease 
of  special  organs. 

A  young  graduate  who,  during  his  college  years,  paid 
especial  attention  to  the  eye,  called  upon  his  professor, 
one  of  the  best  eye  specialists  in  Philadelphia,  and  asked 
him  what  more  he  should  do  to  become  an  eye  specialist. 
The  professor  told  him  to  go  out  into  general  practice 
for  ten  years,  and  then  if  still  ambitious  to  become  an 
eye  specialist,  to  take  a  postgraduate  course  in  one  of 
the  ophthalmic  hospitals  in  America  or  in  Europe,  or  in 
both.     This  advice  was  sound. 

140 


Specialism.  141 

It  takes  practice  to  give  experience;,  and  in  order  to 
develop  a  sound,  broad  vision  of  disease  and  men,  one 
must  be  in  general  practice  for  a  number  of  years.  It 
is  true  that  there  are  many  practicing  surgery  who  have 
not  had  such  experience,  and  yet  perform  some  very 
brilliant  operations.  They  have  the  technic,  the  dex- 
terity, but  not  the  judgment. 

The  real  surgeon  is  not  the  one  who  is  skilful  with 
the  knife,  alone,  but  one  who  is  able  to  decide  when  not 
to  operate  as  well  as  when  and  how  to  operate.  A  first- 
class  surgeon  always  endeavors  to  avoid  operations. 
When  unavoidable,  he  operates  expeditiously.  Unfor- 
tunately, there  are  many  so-called  surgeons  who  have 
commercialized  the  profession,  who  operate  in  order  to 
get  large  fees,  regardless  of  the  requirements  of  the  case. 
Many  persons  have  been  subjected  to  major  operations 
who  would  have  been  better  off  without  the  operation. 
This  is  explained  partly  because  today  for  conservative 
medical  treatment  the  fees  are  comparatively  small, 
while  for  surgery  the  fees  are  large. 

The  public  sentiment  is  at  the  present  time  swinging 
backward  toward  conservatism,  while  a  few  years  ago 
many  who  were  in  apparent  health  applied  to  the  sur- 
geon to  be  operated  upon.  Even  today  the  same  condi- 
tion prevails  in  regard  to  the  tonsil.  The  faddist  has 
overeducated  the  public.  Many  people  look  upon  the 
scar  resulting  from  a  surgical  operation  with  the  same 
degree  of  pride  as  the  Heidelberg  student  regards  the 
scar  received  in  an  encounter  with  his  fellows. 

The  surgeon  is  entitled  to  good  fees  and  should  re- 
ceive them  for  legitimate  operations,  but  at  no  time 
should  he  commercialize  his  profession.     No  j'oung  man 


142  Medicine  as  a  Profession. 

who  is  attracted  to  surgery  by  the  pecuniary  rewards 
should  become  a  surgeon. 

Fees  are  regulated  in  many  respects  as  are  lawyers' 
fees.  They  are  based  upon  the  risk  at  stake,  the  cir- 
cumstances of  the  patient,  the  geographical  location, 
and  the  reputation  of  the  operator.  It  is  nothing  un- 
usual for  operators  in  New  York  to  receive  $2,000  for 
an  appendicitis  operation,  yet  other  skilful  surgeons 
perform  the  same  operation  for  $250. 

The  eye  specialist  is  an  eye  surgeon,  and  performs 
all  the  various  surgeries  of  the  eye  and  its  appendages. 
He,  too,  collects  good  fees,  especially  for  the  surgery 
work.  The  fees  for  cataract  operations  run  from  $100 
to  $1,000;  for  enucleation  from  $50  to  $500;  for  ordi- 
nary office  consultations  and  examinations,  from  $2 
to  $25. 

The  eye  specialist,  designated  as  an  oculist,  is  one 
who  treats  diseases  of  the  eye  and  advises  the  family 
physician  in  the  treatment  of  constitutional  diseases 
which  are  responsible  for  the  eye  manifestation.  Fre- 
quently the  optician,  who  fits  glasses  only,  is  confused 
in  the  minds  of  people  with  the  oculist.  The  optician, 
or  optometrist,  as  he  is  called  in  some  localities,  may  fit 
glasses,  but  not  treat  diseases  of  the  eye,  nor  operate 
upon  the  eye;  while  the  oculist  may  do  whatever  is 
necessary. 

The  ear  specialist  is  to  a  great  degree  a  special  sur- 
geon. The  largest  portion  of  his  work  is  surgical,  and 
very  delicate.  The  mastoid  and  labyrinth  operations 
are  of  the  most  serious  nature,  and  unless  the  operator 
is  thoroughly  familiar  with  the  anatomy  of  the  ear  and 
adjacent  structures,  much  harm  can  result.  The  fees 
are  large. 


Specialism.  143 

One  may  wonder  how  fields  as  restricted  as  ear  or  eye 
practice  conld  demand  much  study.  The  ear  is  small 
and  the  student  may  think  there  is  but  little  to  know 
about  it;  but  volumes  and  volumes  have  been  written 
upon  it  alone,  and  while  the  middle  and  internal  ears 
are  located  deep  within  the  bony  walls  of  the  skull,  there 
is  no  part  of  the  human  organism  as  thoroughly  under- 
stood as  the  ear  in  its  structure,  function  and  treatment. 
The  examination  and  function  tests  are  so  scientific  that 
very  seldom  is  an  ear  specialist  mistaken  in  his  diagnosis. 

The  nose  specialist  treats  diseases  of  the  nose  and  ac- 
cessory sinuses.  The  discoveries  in  medicine  in  the  last 
few  years  lead  to  the  fact  that  much  of  the  general  ill 
health  is  traceable  to  infection  in  these  bony  cavities  of 
the  face.  This  makes  the  nose  specialist  an  important 
factor  in  medicine.  The  larger  part  of  the  work  may 
be  considered  as  surgical  and  the  fees  are  proportionately 
large.  Many  specialists  combine  nose,  throat  and  ear 
practice.  The  close  relationship  between  throat,  ears 
and  nose  makes  it  necessary  for  each  ear  specialist  to 
know  all  about  the  nose  and  throat.  Many  cases  of  ear 
troubles  are  traceable  to  diseased  conditions  of  the  nose. 

One  of  the  fields  in  surgery,  whose  importance  has 
only  of  late  years  become  appreciated  as  it  should  be,  is 
the  field  of  orthopedic  surgery.  One  needs  only  to  visit 
an  orthopedic  ward  in  any  of  the  large  hospitals  and  see 
the  various  appliances,  casts,  splints,  plasters,  braces  and 
exercising  appliances  used  for  the  relief  of  the  unfor- 
tunate little  ones,  and  then  watch  the  entrance  of  the 
surgeon  into  the  ward  to  see  the  radiant  smiles  of  the 
children  who  idolize  the  man  who  is  exercising  his  skill 
in  his  efforts  to  relieve  them.  It  is  wonderful  how  appre- 
ciative the  patients  are.    While  it  is  a  fact  that  many  of 


144  Medicine  as  a  Profession. 

these  patients  are  poor  and  the  returns  from  a  financial 
point  of  view  are  not  as  large  as  those  from  other  sur- 
gical work,  yet  there  is  no  field  of  medicine  in  which  the 
kind,  patient,  gentle  touch  of  the  physician  commands 
such  lasting  gratitude  of  society  as  in  orthopedic  sur- 
gery. So  far,  in  this  country,  in  many  localities  this 
work  is  attended  to  by  general  practitioners  or  general 
surgeons  who  are  often  incompetent  and  cannot  render 
the  best  service  to  the  patient.  The  treatment  of  de- 
formities is  peculiarly  a  work  for  the  specialist  because 
no  two  cases  are  similar.  The  specialist  must  be  a  skil- 
ful physician,  mechanic  and  surgeon.  Much  of  the 
work  is  mechanical  adjustment,  and  each  case  must  be 
treated  individually;  the  appliances  must  be  changed  a 
little  here  and  there  from  time  to  time,  and  braces  must 
be  devised  to  suit  each  case. 

Some  physicians  make  children's  disease  a  special 
practice.  One's  practice  cannot  be  restricted  to  the 
treatment  of  children  exclusively,  except  in  few  instances 
in  larger  cities ;  even  then  it  must  be  as  a  consultant  to 
general  practitioners.  The  treatment  of  children's  dis- 
eases is  very  similar  to  the  work  with  adults,  because 
the  diseases  as  a  rule  are  the  same  as  those  of  adults. 
So  this  work  is  usually  taken  up  by  general  practitioners 
who  give  especial  attention  to  children  in  connection 
with  their  general  practice. 

The  specialist's  practice  consists  more  of  consultation 
work  with  other  physicians  than  of  dealing  directly  with 
the  public.  To  command  a  lucrative  special  practice 
one  must  be  able  to  meet  colleagues  diplomatically;  to 
differ,  if  need  be,  with  the  diagnosis  of  the  family  phy- 
sician without  disturbing  the  confidence  of  the  family  in 
their  physician ;  to  be  thorough,  competent,  conservative 


Specialism.  145 

and  polite.  He  should  not  resort  to  rebating  or  to  the 
granting  of  a  percentage  of  his  fees  to  the  family  phy- 
sician who  recommends  him.  These  practices  are  some- 
times resorted  to  by  unscrupulous  specialists.  The  prac- 
tice is  vicious  because,  under  such  conditions,  many 
physicians  recommend  specialists,  not  the  most  skilful, 
but  from  whom  they  get  the  largest  commission.  There 
are  also  men  who  advertise  in  the  daily  press  as  special- 
ists offering  free'  consultations  and  a  guarantee  cure. 
No  one  should  consider  such  a  commercialized  practice 
for  a  moment  in  choosing  a  vocation.  It  is  not  consid- 
ered an  honorable  practice  and  should  be  discouraged. 
The  guarantee  cannot  be  enforced  if  the  cure  is  not 
made.  The  money  paid  cannot  be  recovered  legally  on 
account  of  so  many  elements  that  can  enter  into  a  case 
which  cannot  be  controlled. 


CHAPTER  XXVI. 

Women  in  Medicine. 

This  is  not  the  place  to  determine  the  merits  of  the 
arguments  on  the  two  sides  of  the  debate  between  the 
feminist  who  claims  the  whole  field  of  medicine  for 
women  by  right  of  prior  occupation  and  natural  adapta- 
tion; and  the  crusty  old  specialist  who  says  that  the 
prejudice  against  women  in  medicine  is  probably  primal 
in  its  origin,  and  the  more  generous  man  who  says  that 
women  have  not  been  so  successful  in  medicine  as  they 
have  deserved,  because  other  women  do  not  have  a  suffi- 
cient degree  of  confidence  in  them. 

Both  sides  could  prove  their  contentions  by  quoting 
these  figures  from  the  last  census,  which  show  for  the 
entire  country. 

Male.  Female. 

Physicians  and  surgeons  ....   142,116  9,015 

Trained  nurses 5,819  76,508 

Nurses  not  trained 15,926  110,912 

Total r6^;023  207,312 

In  1900,  women  comprised  5  per  cent,  of  the  whole 
number  of  physicians  and  surgeons,  and  in  1910,  6  per 
cent.,  while  the  great  army  of  women  in  the  field  of 
trained  nursing  is  almost  entirely  a  development  of  the 
twentieth  century.  It  is  evident  that  women  are  doing 
their  part  in  caring  for  the  sick  and  unfortunate.  On 
the  other  hand  it  appears  that,  in  the  field  of  medicine 

146 


Photo   by  H.  D.  Jones  from    Underwood  &    Undenvood,  N.    Y 

Demonstration  Before  Students 
Women's   Medical    College   of    Pennsylvania 


Women"  in  Medicine.  147 

proper,  the  number  of  women  students  enrolled  in  the 
medical  colleges  in  1904  was  4.3  per  cent.,  and  in  1914, 
3.8  per  cent.,  of  all  the  students  enrolled ;  and  the  num- 
ber of  female  graduates  in  medicine  was  4  per  cent,  of 
the  entire  number  of  graduates  in  1904,  and  3.4  per 
cent,  in  1914.  The  number  of  female  medical  students 
in  attendance  upon  the  medical  colleges  was  1,129  in 
1904  and  only  631  in  1914.  Of  these  only  about  20 
per  cent,  were  in  attendance  at  the  two  women's  medical 
colleges,  while  the  larger  number  attended  coeducational 
institutions. 

An  expert  in  medical  education,  commenting  upon 
these  figures,  says:  "Now  that  women  are  freely  ad- 
mitted to  the  medical  profession,  it  is  clear  that  they 
show  a  decreasing  inclination  to  enter  it.  More  schools 
are  open  to  them;  fewer  attend  and  fewer  graduate. 
True  enough,  medical  schools  generally  have  shrunk; 
but  as  the  opportunities  for  women  have  increased,  not 
decreased,  within  a  year  during  which  entrance  require- 
ments have,  so  far  as  they  are  concerned,  not  materially 
altered,  their  enrollment  should  have  been  augmented, 
if  there  were  any  strong  demand  for  women  physicians 
or  any  strong  ungratified  desire  on  the  part  of  women 
to  enter  the  profession.  One  or  the  other  of  these  con- 
ditions is  lacking,  perhaps  both." 

The  president  of  one  of  the  state  medical  associations, 
upon  being  interviewed,  summed  up  the  whole  matter 
somewhat  as  follows: 

"There  are  fields  of  medicine  for  which  women  are 
peculiarly  adapted ;  the  foreign  mission  field,  the  school 
inspection  service,  especially  where  the  work  is  with 
girls,  the  examination  of  women  factory  employees,  the 
personal  and  social  hygiene  service  of  pubKc  health 


148  Medicine  as  a  Profession. 

work,  and  the  examination  of  women  applicants  for  life 
insurance  and  in  the  health  service  of  the  industrial  life- 
insurance  companies.  There  is  no  reason  why  women 
should  not  succeed  as  specialists  in  the  treatment  of  the 
eye,  ear  and  nose,  in  children's  disease,  and  bacteriolog- 
ical and  biological  laboratory  work. 

"  There  is  an  unlimited  field  in  China  and  India  for 
women  physicians  who  have  been  trained  in  western 
methods.  The  customs  of  the  countries  have  established 
rules  whose  violation  is  not  excused  by  even  the  most 
extreme  forms  of  suffering.  Not  only  is  the  progress  of 
the  medical  missions  hindered  by  this  lack  of  women 
physicians,  but  it  is  gradually  becoming  possible  for 
them  to  establish  themselves  in  other  connections  and 
with  other  associations. 

"  In  the  treatment  of  diseases  peculiar  to  women 
female  practitioners  have  established  lucrative  practices. 
Few  persons  realize  the  extent  to  which  cancer  of  the 
female  reproductive  organs  prevails.  The  early  symp- 
toms are  of  such  an  intimate  nature  that  women  will 
not  discuss  them  with  a  male  physician.  With  the  ad- 
vent of  the  female  physician,  these  early  symptoms  will 
be  more  likely  to  receive  proper  treatment. 

"The  treatment  of  nervous  disorders  which  are  so 
often  to  be  traced  to  discordant,  uncongenial  and  in- 
compatible social  relations,  the  handling  of  cases  of 
houses  of  refuge  for  wayward  women,  and  the  work  with 
women  in  asylums  and  hospitals,  should  make  a  special 
appeal  to  women  who  are  seeking  a  life  career. 

"As  preventative  medicine  becomes  more  and  more 
emphasized,  and  the  great  value  of  personal  hygiene 
and  domestic  sanitation  becomes  more  fully  recognized, 
there  will  be  a  demand  for  a  much  larger  number  of 


Women  in  Medicine.  149 

women  to  conduct  campaigns  of  education  under  the 
auspices  of  the  public  health  authorities  in  congested 
quarters  of  our  cities  and  in  rural  communities. 

"With  the  inauguration  of  efficiency  campaigns  and 
weKare  work  by  corporations,  there  will  be  an  increased 
demand  for  women  with  medical  training  to  direct  this 
work  for  the  concerns  which  employ  large  numbers  of 
women  and  girls.  Ex-president  Roosevelt,  in  comment- 
ing upon  a  section  of  the  factory  laws  providing  for  the 
physical  examination  of  employees,  was  one  of  the  first 
to  call  attention  to  the  need  for  women  to  conduct  these 
examinations  of  female  workers. 

"  Historically  speaking,  we  may  say  that  it  has  only 
been  in  this  country,  and  during  a  comparative  short 
space  of  years,  that  it  has  become  the  accepted  custom 
to  call  in  male  physicians  in  confinement  cases,  and  it 
seems  that  women  are  again  entering  upon  this  work, 
by  nature  their  own. 

"  In  surgery  there  are  many  women  who  have  demon- 
strated their  success  in  major  operations.  In  the  hos- 
pital connected  with  the  colleges  for  women,  very  skilful 
operations  are  performed.  In  the  New  York  hospital, 
operations  for  appendicitis  have  been  performed  in 
twelve  minutes.  One  may  enter  this  operating  room 
and  observe  the  surgeons  with  their  heads,  nose  and 
lower  parts  of  the  face  covered,  with  their  operating 
gowns  reaching  to  their  feet,  as  is  customary  in  all  hos- 
pitals, without  any  thought  that  anything  out  of  the 
ordinary  is  going  on.  If  there  is  any  difference  it  is  to 
be  noted  that  perhaps  they  are  more  conservative  than 
men;  and  those  familiar  with  the  healing  art  recognize 
that  in  surgery  conservatism  is  a  virtue,  not  a  fault." 


150  Medicine  as  a  Profession". 

In  preceding  chapters,  reference  has  been  made  to 
the  work  which  women  are  doing  in  medical  laboratories. 

The  natural  conservatism  of  women  may  explain  why 
larger  numbers  have  not  entered  this  field.  The  woman 
who  must  plan  for  herself  a  wage-earning  career  cannot 
often  command  the  funds  to  make  the  outlay  which 
preparation  for  medicine  demands;  nor  is  she  often  in 
a  position  to  regard  with  equanimity  the  long  years  of 
unremunerative  work.  Furthermore,  on  account  of  the 
comparative  small  number  of  female  candidates  who 
apply  to  the  hospital  for  service,  it  has  been  difficult  to 
persuade  the  hospital  authorities  to  mke  those  changes 
which  are  necessary  to  provide  for  a  mixed  staff  of  in- 
ternes and  house  physicians. 

In  conclusion,  it  may  be  said  that  there  never  was  a 
time  when  it  was  so  easy  for  a  woman  to  prepare  herself 
for  this  field,  and  when  there  were  fewer  obstacles  placed 
in  her  path. 


Laboratory  and  Operating  Room  Southern  Pacific  Hospital, 

San  Francisco 


CHAPTER  XXYII. 

The  Future  of  Medicixe. 

In  these  days  of  rapid  changes,  a  young  man  does 
not  care  to  make  large  investments  of  time  and  money 
in  preparing  for  a  life  work  without  considering  what 
changes  are  likely  to  occur  during  his  active  period  of 
life  in  the  particular  field  under  consideration.  Of 
course  all  prophecy  is  but  speculation  and  must  be  ac- 
cepted as  such;  and  every  man  is  privileged  to  indulge 
his  own  fancies  in  this  direction. 

Through  the  greater  part  of  the  nineteenth  century, 
medical  men  insisted  that  the  public  should  regard  them 
as  possessing  a  field  of  knowledge  exclusively  their  own 
and  that  they  were  endowed  with  superior  wisdom, 
much  of  which  they  tried  to  conceal  in  the  technical 
language  of  the  profession;  and  through  the  adoption 
of  their  own  code  of  ethics  they  protected  the  members 
of  their  craft  from  the  judgment  of  the  lay  public. 
However,  they  reserved  to  themselves  the  right  to  deter- 
mine who  should  be  admitted  to  their  own  ranks  and 
under  what  conditions  they  should  be  received.  They, 
however,  failed  to  establish  a  standard  of  education  by 
which  the  general  average  of  practitioners  was  kept 
apace  with  the  advances  made  by  their  best  men.  As  a 
result  the  state  stepped  in  and  made  laws  for  the  regu- 
lation of  medicine  through  the  special  examining  boards 
which  were  constituted  to  determine  the  qualifications 
of  those  who  desired  to  enter  the  profession. 

11  151 


152  Medicine  as  a  Peofessioit. 

As  knowledge  advanced  and  the  social  organization 
became  more  complex,  it  became  evident  that  the  se- 
curity of  the  life  of  the  individual  depended  as  much 
upon  the  nature  of  his  environment  as  upon  the  knowl- 
edge and  skill  of  his  medical  adviser,  and  that  the 
physician  in  his  individual  capacity  could  not  always 
control  his  environment;  this  led  up  to  movements  for 
the  purpose  of  encouraging  preventative  medicine,  sani- 
tation and  such  effective  organization  of  medical  staffs 
as  to  make  it  possible  to  bring  to  bear  upon  any  com- 
plicated case  or  any  emergency,  either  for  the  benefit  of 
the  individual  or  the  protection  of  the  public,  the  best 
of  specialized  skill  and  the  whole  of  that  enormously 
expanded  field  of  knowledge  which  has  long  since  out- 
grown the  compass  of  any  one  man. 

The  community  for  its  protection  has  organized  an 
army  and  a  navy.  The  members  who  were  serving  thQ 
community  in  connection  with  this  branch  of  the  gov- 
ernment must  be  kept  in  a  fit  condition,  and  it  was  the 
part  of  wisdom  to  establish  a  medical  corps  consisting  of 
salaried  members.  The  sufferings  of  the  poor  enlisted 
the  sympathies  of  a  prosperous  and  enlightened  people. 
Relief  was  organized  as  a  measure  of  economy,  and  to 
minister  to  the  charges  of  the  state  another  body  of 
salaried  physicians  was  created.  Science  advanced  and 
systematic  sanitary  measures  became  necessary  to  secure 
the  results  of  scientific  discoveries.  Organization  be- 
came necessary  and  another  body  of  salaried  scientific 
men,  mostly  physicians  at  the  outset,  was  created  and 
thus  has  the  movement  grown  towards  organization  for 
carrying  on  protective  measures  on  a  large  scale. 

A  canvass  of  the  subject  in  England,  before  the  out- 
break of  the  war,  showed  that  fully  one  fourth  of  all  the 


Kg- 


H 

< 


The  Future  of  Medicine.  153 

registered  physicians  were  either  employed  on  full-time 
salaried  positions,  or  else  are  performing  some  paid 
office  in  connection  with  their  private  practice.  Eefer- 
ence  has  already  been  made  to  the  large  expenditures 
which  our  states  and  cities  are  making  for  maintaining 
organized  work  in  this  field ;  and  in  the  absence  of  defi- 
nite figures  it  is  safe  to  say  that  governmental  expenses 
for  public  health  purposes,  sanitary  supervision  and 
charitable  medical  service  have  doubled  within  the  last 
ten  years.  Does  this  mean  the  complete  socialization  of 
medicine ;  that  every  school  district  in  the  country  shall 
have  its  physician  to  treat  all  the  people  free  as  it  has 
its  teacher  to  instruct  their  children,  at  public  expenses ; 
and  that  every  city  shall  have  its  organized  staff  of  spe- 
cialists and  general  practitioners  supported  at  the  public 
expense,  in  the  same  way  that  it  supports  its  specialists 
for  fire  protection,  police  protection  and  instruction? 

On  all  sides  we  hear  complaints  from  medical  men  of 
the  hardships  to  which  they  are  subjected.  There  is  the 
burden  of  carrying  with  them  in  the  rounds  of  their 
general  practice  the  accumulated  funds  of  knowledge, 
much  of  which  they  need  only  on  very  rare  occasions; 
there  is  the  isolation  which  is  due  to  the  individual 
nature  of  their  work;  there  is  the  difficulty  of  keeping 
up  with  the  latest  developments  in  technical  skill;  then 
the  business  relations  between  physician  and  patient  and 
between  general  practitioner  and  specialist  are  far  from 
satisfactory;  the  separate  domains  of  the  public  health 
service  and  of  the  private  practitioner  are  but  vaguely 
defined,  and  the  public  supervision  of  private  practice 
is  proving  to  be  a  source  of  irritation. 

As  the  medical  graduate  becomes  imbued  more  and 
more  with  the  scientific  spirit,  which  ever  seeks  for  re- 


154  Medicine  as  a  Profession". 

suits,  little  comfort  in  failure  is  found  in  the  thought 
that  the  traditional  methods  have  been  followed  in 
handling  a  case.  There  comes  dissatisfaction,  especially 
when  the  physician  considers  such  figures  as  he  receives 
from  the  hospitals,  which  show  that  the  autopsies  which 
are  performed  on  the  dead  failed  to  confirm  over  70 
per  cent,  of  the  diagnoses.  He  is  forced  to  the  conclu- 
sion that  no  one  man  alone  can  command  for  the  benefit 
of  a  patient,  in  extraordinary  cases,  the  best  which  the 
past  has  accumulated ;  and  there  comes  to  him  the  possi- 
bility of  team  work,  which  will  lessen  his  burdens,  en- 
large his  usefulness  and  increase  his  efficiency. 

Unfortunately  medicine  does  not  generally  appeal  to 
the  young  man  with  a  capacity  for  organization  and 
leadership  as  do  some  of  the  industrial  and  commercial 
fields  in  which  the  rewards  for  this  kind  of  endowment 
are  better  known  and  there  is  little  in  the  studies  of  the 
medical  course  and  less  in  the  routine  of  the  practitioner 
to  develop  this  special  capacity. 

It  is  true  that  the  hospitals  for  treating  the  poor  are 
so  organized  in  our  large  cities  that  the  patient  who 
comes  to  them  after  he  is  sick  or  afflicted  is  turned  over 
to  the  one  man  of  the  staff  who  handles  a  specialty,  and 
who  has  at  his  command  every  facility  for  handling  the 
case,  but  as  a  rule  these  staff  physicians  are  beginners, 
who  handle  this  work  in  a  routine  way,  more  as  a  trade 
than  as  a  profession.  On  the  other  hand,  a  beginning 
has  been  made  in  the  organization  of  private  sanita- 
riums in  which  there  is  a  staff  of  high-grade  specialists 
so  organized  as  to  bring  to  bear  upon  any  one  case  the 
collective  wisdom  and  skill  of  the  entire  body.  These, 
however,  reach  individuals  only  during  limited  periods 
of  the  disease  and  do  not  succeed  in  realizing  the  dreams 


The  Future  of  Medicine.  155 

of  the  general  practitioner,  who  is  persuaded  that  his 
highest  effectiveness  comes  from  caring  for  individuals 
rather  than  from  treating  morbid  humanity. 

Some  day  there  will  arise  a  genius  who  will  map  out 
for  himself  a  community  and  go  to  the  members  and  say 
that  he  will  organize  a  staff  of  highly  trained  men  and 
place  them  in  an  establishment  in  which  they  will  have 
at  their  command  the  best  of  equipment  and  for  an 
annual  fee  will  always  have  at  their  service  and  call 
this  fully  organized  machinery  not  only  for  the  treat- 
ment of  the  sick  but  to  counsel  and  guard  against  sick- 
ness. 

As  these  words  are  written  there  comes  to  hand  the 
record  of  the  work  which  is  done  by  the  University  of 
California.  There  it  has  been  shown  that  by  charging 
the  students  an  annual  fee  of  five  dollars  for  medical 
service  the  institution  can  maintain  a  self-supporting 
body  of  salaried  high-grade  specialists  who  are  at  the 
command  of  the  students  at  all  times  for  advice,  consul- 
tation and  treatment.  At  the  same  time  there  comes 
the  information  that  Harvard  University,  the  Univer- 
sity of  Michigan  and  the  University  of  Wisconsin  have 
set  on  foot  schemes  of  similar  kinds ;  and  that  they  are 
not  only  placing  organized  medical  faculties  at  the 
service  of  the  individual  students,  but  that  they  are 
making  medical  examination,  at  stated  intervals,  com- 
pulsory. 

The  unrest  in  the  medical  profession,  the  general  dis- 
satisfaction of  a  lay  public  which  has  in  recent  years 
become  better  and  better  informed  of  the  larger  possi- 
bilities for  a  more  economical  and  better  medical  service, 
presages  a  revolution,  and  the  question  to  be  determined 
is  whether  that  revolution  will  be  worked  out  by  the 


156  Medicine  as  a  Profession". 

profession  through  organization  from  within,  for  the 
wider  service  and  protection  of  the  public,  as  the  life 
insurance  and  fire  insurance,  the  lighting  of  residences 
has  been  brought  about  by  organizations  which  serve  the 
individual  for  an  annual  fee;  or  whether  it  will  be  ac- 
complished by  the  complete  socialization  of  medicine, 
so  that  this  service  for  the  entire  body  of  the  public  will 
be  performed  by  salaried  officials  paid  out  of  public 
funds,  in  the  same  way  that  the  public  provides  the 
schooling  for  its  children,  its  police  protection,  its  fire 
protection,  its  water  supplies  and  the  sewerage  of  its 
cities  and  the  lighting  of  its  streets. 

Whether  the  larger  service  is  worked  in  one  way  or 
the  other  the  tendency  will  likely  be  to  raise  the  poor 
practitioner  to  a  higher  standard  or  eliminate  him  en- 
tirely and  it  will  also  mean  a  leveling  down  by  doing 
away  with  the  large  monetary  returns  to  the  acknowl- 
edged leaders  in  medicine  and  surgery,  but  it  will  result 
in  increasing  the  general  average  of  income  and  satis- 
factions to  the  men  in  the  profession.  It  will  conduce 
to  more  conservatism,  by  the  destruction  of  the  vicious 
fee-splitting  and  commission-paying  practices,  that  are 
indulged  in  by  the  unscrupulous  and  the  self-seeking. 


CHAPTEE  XXYIII. 

Medical  Laws. 

The  legislative  requirements  for  the  practice  of  medi- 
cine are  interpreted  for  the  several  states  by  their  re- 
spective boards  of  medical  examiners.  The  standards 
vary  greatly,  and  while  in  one  state  a  person  may  law- 
fully prescribe  for  the  sick,  and  operate  upon  the  de- 
formed, across  the  boundary  in  an  adjoining  state  such 
service  may  be  regarded  as  a  misdemeanor.  All  these 
boards  of  examiners,  however,  require  that  the  applicant 
for  a  certificate  must  be  a  person  of  good  character, 
must  possess  a  diploma  from  a  reputable  medical  col- 
lege and  must  pass  examinations  in  anatomy,  physiology, 
pathology,  chemistry,  hygiene,  surgery,  obstetrics  and 
gynecology.  In  some  states  there  are  separate  boards 
to  examine  the  graduates  in  particular  systems  of  medi- 
cine, and  in  states  where  there  is  a  single  board  there  are 
usually  appointed  to  this  board  representatives  of  the 
regular,  eclectic  and  homeopathic  schools  of  medicine, 
and  the  applicant  may  request  to  be  examined  upon 
therapeutics  and  the  materia  medica  by  those  members 
who  represent  his  own  system  or  school. 

The  boards  .of  examiners  of  particular  states  usually 
accept  certificates  which  are  issued  by  other  states  whose 
standards  of  requirements  are  equal  to  their  own;  and 
by  addressing  a  letter  of  inquiry  to  the  board  of  medical 
examiners  at  the  state  capitol,  applicants  can  find  out 
whether,  at  the  time,  the  certificate  of  examination  which 

157 


158  Medicine  as  a  Pkoeession. 

they  hold  from  any  state  is  honored  by  another  state. 
Holders  of  certificates  or  licenses  to  practice  in  one 
state  are  generally  expected  to  pay  a  fee  or  tax  in  order 
to  have  their  licenses  validated  for  other  states;  but  in 
most  of  the  states  there  are  special  regulations  which 
permit  physicians  licensed  by  adjoining  states  to  wait 
upon  patients  in  nearby  counties  across  the  state  bound- 
aries, and  they  also  concede  the  right  to  physicians 
from  other  states  to  act  as  consultants;  and  allow  the 
regular  appointed  officers  of  the  army  and  navy  or  of 
railroads  to  follow  their  professional  work  within  states 
in  which  they  do  not  hold  licenses. 

Sections  of  the  medical  laws  of  the  state  of  New 
York  and  Pennsylvania  are  given  at  some  length.  The 
applicant  who  can  meet  these  requirements  can  qualify 
in  any  state.  At  the  end  of  the  chapter  a  tabular  state- 
ment is  given  of  the  requirements  for  all  of  the  states. 

In  New  York  the  Board  of  Medical  Examiners  is 
constituted  by  the  Eegents  of  the  University  of  the 
State  of  New  York,  which  is  the  name  by  which  the 
department  of  education  is  known,  and  this  university 
includes  all  duly  organized  schools  controlled  by  the 
educational  officers  of  the  state. 

No  persons  shall  be  licensed  to  practice  who  have 
been  convicted  of  a  felony;  nor  shall  any  person  be 
licensed  after  1891  except  in  accordance  with  this  law. 
The  regents  shall  admit  to  the  medical  examination  any 
person  who  pays  a  fee  of  $25  and  submits  evidence 
verified  by  oath,  and  satisfactory  to  the  examiners,  that 
he  is  more  than  twenty-one  years  old,  is  of  good  moral 
character,  has  had,  prior  to  entrance  upon  the  second 
year  of  medical  study,  the  academic  education  which  is 
prescribed  by  law,  and  has  studied  medicine  at  a  school 


Medical  Laws.  159 

which  has  been  duly  registered  as  satisfactory  by  the 
Regents  and  been  in  attendance  at  snch  school  for  a 
period  covering  four  different  calendar  years  upon 
courses  covering  at  least  seven  months  of  each  year. 
Evidence  of  five  or  more  years  of  reputable  practice 
may  be  accepted  as  an  equivalent  for  the  requirements 
of  the  third  or  fourth  years  of  the  medical  courses ;  and 
evidence  of  graduation  from  a  recognized  college  may 
be  accepted  as  equivalent  to  the  work  of  the  first  of  the 
four  years  in  the  medical  school. 

Applicants  to  practice  osteopathy  shall  produce  evi- 
dence that  they  have  studied  not  less  than  four  years, 
including  courses  of  not  less  than  seven  months  each, 
at  a  school  satisfactory  to  the  Regents.  From  time  to 
time  the  board  issues  circulars  of  information  in  which 
the  different  schools  maintaining  satisfactory  standards 
are  listed.  These  circulars  can  be  obtained  by  address- 
ing the  Board  of  Regents,  Albany,  N.  Y. 

The  law  prescribes  that  the  Board  of  Medical  Ex- 
aminers shall  submit  to  the  Regents  for  their  approval, 
suitable  questions  for  examinations  in  anatomy,  physi- 
ology, hygiene,  sanitation,  chemistry,  surgery,  obstet- 
rics, gynecology,  pathology,  including  bacteriology  and 
diagnosis. 

Examinations  shall  be  held  at  four  different  places 
in  the  state,  four  times  annually,  and  the  examination 
shall  be  in  writing  and  shall  be  conducted  by  examiners 
appointed  by  the  Regents,  who  shall  deliver  the  papers 
to  the  authorized  committees.  The  papers  shall  be 
marked  without  delay  and  returned  with  an  official 
report  giving  the  percentages  obtained  by  each  candi- 
date in  each  subject.     A  candidate  who  fails  upon  the 


160  Medicine  as  a  Profession". 

first  examination  may  have  a  second  trial  within  six 
months,  without  paying  an  additional  fee. 

The  Commissioner  of  Education  may  at  his  discre- 
tion, upon  the  approval  of  the  Eegents,  endorse  the 
license  or  diploma  of  a  physician  from  another  state 
provided  the  applicant  has  met  all  the  preliminary  and 
professional  qualifications  for  earning  a  license  in  this 
state,  has  been  in  reputable  practice  for  a  period  of  ten 
years,  and  has  reached  a  position  of  conceded  eminence 
or  authority  in  the  profession. 

Before  beginning  to  practice,  the  holder  of  a  license 
shall  have  the  same  registered  in  the  office  of  the  clerk 
of  the  county  where  such  practice  is  to  be  carried  on, 
producing  proper  evidence  that  he  is  the  person  to 
whom  the  license  has  been  issued  and  that  he  has  com- 
plied with  all  the  requirements  of  the  laws  governing 
the  practice  of  medicine,  that  no  money  except  the 
regular  fees  has  been  paid  for  such  license,  and  that  he 
has  not  been  guilty  of  any  fraud  or  misrepresentation 
in  securing  his  credentials.  He  shall  receive  a  certifi- 
cate of  such  registration,  for  which  he  shall  pay  a  fee 
of  one  dollar. 

A  license  to  practice  medicine  may  be  revoked  if  it  is 
found  that  the  practitioner  has  been  guilty  of  any  fraud 
or  deceit  in  securing  his  credentials ;  if  he  is  an  habitual 
drunkard  or  addicted  to  the  use  of  morphine,  opium  or 
cocaine;  if  he  violates  any  of  the  laws  governing  the 
practice  of  medicine. 

Nothing  in  the  law  shall  be  so  construed  as  to  affect 
commissioned  medical  officers  serving  in  the  army,  the 
navy  or  the  marine  hospital  service,  while  so  commis- 
sioned, or  any  one  while  serving  on  the  medical  staff  of 
a  legally  incorporated  hospital. 


Medical  Laws.  161 

The  law  of  1912  for  the  state  of  Pennsylvania  is  very 
similar  to  the  law  of  New  York.  The  Bureau  of 
Medical  Education  and  Licensure  is  under  the  jurisdic- 
tion of  the  Superintendent  of  Public  Instruction.  This 
Bureau  prepares  annually  a  list  of  medical  colleges  and 
schools  which  are  satisfactory  to  the  department,  and 
which  require  of  applicants  for  a  medical  degree  a 
satisfactory  high-school  education,  together  with  one 
or  more  years  of  work  in  chemistry,  biology  and  phys- 
ics in  an  approved  college,  and  maintain  graded  medical 
and  surgical  courses  of  four  years,  of  not  less  than 
thirty-two  weks  each  of  not  less  than  thirty-five  hours 
of  work,  in  didactic,  laboratory  and  clinical  studies. 

Applicants  for  the  medical  examination  must  furnish 
satisfactory  proof  of  being  twenty-one  years  of  age,  of 
good  moral  character,  not  addicted  to  the  intemperate 
use  of  alcoholics  or  narcotic  drugs,  and  that  they  have 
complied  with  the  requirements  as  to  preliminary  edu- 
cation and  attendance  upon  a  duly  authorized  and  ap- 
proved medical  school,  have  successfully  passed  each  of 
the  courses  prescribed  by  such  school  and  served  as  an 
interne  for  one  year  at  a  hospital  having,  at  least, 
twenty-five  beds  for  each  interne. 

The  medical  examination  shall  be  in  writing,  but  may 
be  supplemented  by  oral  examinations,  by  laboratory 
tests  or  by  bedside  examinations.  The  examinations 
shall  be  conducted  at  such  times  and  places  as  may  be 
designated  by  the  Bureau,  and  specially  qualified  as- 
sistants may  be  called  in  to  assist  in  conducting  the 
examinations. 

The  subjects  of  the  examination  shall  include :  anat- 
omy, physiology,  chemistry  as  applied  to  medicine, 
pathology,    bacteriology,    symptomatology,    diagnosis, 


162  Medicine  as  a  Peoeession. 

surgery,  gynecology  and  obstetrics.  The  examination 
in  therapeutics  and  materia  medica  is  to  be  conducted 
by  members  of  the  Bureau  who  are  of  the  same  school 
of  medicine  as  the  candidate.  The  law  also  provides 
for  partial  examinations  at  the  end  of  the  second  year 
of  medical  study,  exempting  the  applicant  who  passes 
any  subjects  at  this  examination  from, further  exami- 
nation upon  those  subjects  at  the  final  examinations. 

From  a  table  published  in  the  Journal  of  the  Amer- 
ican Medical  Association  in  its  annual  state  board  issue 
it  appears  that  from  1912  to  1916  inclusive  545  of  the 
4283  graduates  who  appeared  before  the  state  boards 
for  examination  failed.  During  those  same  years  none 
failed  in  Idaho,  Iowa,  Minnesota,  Nebraska,  New  Hamp- 
shire, Utah,  Vermont,  Washington,  and  Idaho.  During 
the  same  years,  36  per  cent,  of  the  applicants  were  re- 
jected in  Mississippi ;  20  per  cent,  in  New  York ;  20  per 
cent,  in  South  Carolina ;  30  per  cent,  in  Oregon.  It  ap- 
pears that  in  those  states  reporting  large  percentages  of 
failures  the  proportion  of  failures  was  greater  among 
the  applicants  who  were  graduated  from  colleges  outside 
of  those  states  than  from  graduates  from  colleges  in  the 
respective  states  which  seems  to  indicate  that  a  student 
is  more  likely  to  fulfill  all  the  requirements  of  a  state 
board  in  a  particular  state  if  he  has  been  graduated  from 
a  college  located  in  that  state. 

The  lack  of  uniformity  of  standards  is  also  indicated 
by  the  variation  of  the  number  of  failures  by  the  gradu- 
ates of  the  same  institutions  in  different  years.  Of  one 
leading  institution  10  per  cent,  of  the  graduates  were 
rejected  by  the  state  boards  in  the  years  from  1912  to 
1916  inclusive  and  only  5  per  cent,  in  the  latter  year; 
of  another  large  college  6  per  cent,  failed  in  the  former 


Medical  Laws.  163 

period  and  none  in  the  latter.  For  all  the  colleges  the 
percentage  of  failures  was  20J  per  cent,  in  1912  as 
against  15  per  cent,  in  1916.  This  improved  result  un- 
doubtedly indicates  that  standards  are  becoming  more 
uniform. 

The  lack  of  uniformity  of  standards  has  resulted  in  a 
movement  for  the  establishment  of  a  federal  board  for 
granting  licenses  which  are  to  be  good  for  the  entire 
country.  Such  a  board  has  been  constituted  but  at  pres- 
ent it  has  no  official  status  but  it  is  believed  that  the 
several  state  boards  will  take  steps  to  validate  the  licenses 
issued  by  this  national  board. 

The  medical  laws  do  not  regulate  the  conduct  of  a 
physician  after  he  secures  his  license  to  practice,  but  if 
it  can  be  proven  that  he  has  failed  to  exercise  due  dili- 
gence and  care  in  his  duties  to  his  patients  he  may  be 
held  for  damages  for  malpractice,  "\\niile  it  is  difficult 
for  a  patient  to  establish  before  a  court  claims  for  dam- 
ages, suits  of  this  kind  are  so  injurious  to  a  physician 
that  every  precaution  must  be  taken  to  forestall  them. 
There  are  insurance  companies  which  undertake  for  an 
annual  fee  to  afford  to  practitioners  protection  against 
suits  of  this  kind  by  supplying  to  their  clients  at  the 
expense  of  the  company,  attorneys  for  their  defense  and 
by  paying  damages  in  cases  which  result  unfavorably  to 
the  defendant. 

A  summary  of  the  medical  laws  of  the  several  states 
will  be  found  in  the  Appendix. 


CHAPTER  XXIX. 

The  Code  of  Medical  Ethics. 

As  a  final  indication  of  the  peculiar  position  of  the 
physician  we  give  in  this  closing  chapter  a  summary  of 
professional  ethics  as  set  forth  in  the  Hippocratic  Oath, 
which  has  been  subscribed  to  by  physicians  for  over  two 
thousand  years,  and  as  embodied  in  one  of  the  several 
approved  modern  statements  of  the  code  of  medical 
ethics. 

The  Hippocratic  Oath, 

I  swear  by  Apollo,  the  physician,  and  ^sculapius, 
and  Health  and  All  Heal  and  all  the  Gods  and  God- 
desses, that  according  to  my  ability  and  judgment,  I 
will  keep  this  oath  and  this  stipulation;  to  reckon  him 
who  taught  me  this  art  equally  dear  to  me  as  my 
parents;  to  share  my  substance  with  him  and  relieve  his 
necessities  if  required ;  to  look  upon  his  offspring  on  the 
same  footing  as  my  own  brothers  and  to  teach  them  this 
art  if  they  shall  wish  to  learn  it,  without  fee  or  stipula- 
tion, and  that  by  precept,  lecture,  and  every  other  mode 
of  instruction,  I  will  impart  a  knowledge  of  the  Art  to 
my  own  sons  and  those  of  my  teachers,  and  to  disciples 
bound  by  a  stipulation  and  oath,  according  to  the  law 
of  medicine  but  to  none  others;  I  will  follow  the  sys- 
tem of  regimen  which  according  to  my  ability  and  judg- 
ment, I  consider  for  the  benefit  of  my  patients,  and  ab- 
staining fpom  whatever  is  deleterious  and  mischievous, 

164 


Hippocrates 
The    Father    of    Medicine 


The  Code  of  Medical  Ethics.  165 

I  will  give  no  deadly  medicine  to  any  one  if  asked  nor 
suggest  any  such  counsel,  but  with  purity  and  holiness 
I  will  pass  my  life  and  practice  my  art.  Into  whatever 
houses  I  enter  I  will  go  into  them  for  the  benefit  of  the 
sick,  and  will  abstain  from  every  voluntary  act  of  mis- 
chief and  corruption,  and  further  from  the  seduction  of 
females  or  males,  of  freemen  and  slaves. 

Whatever  in  connection  with  my  professional  prac- 
tice or  not,  I  see  or  hear,  in  the  life  of  men,  which  ought 
not  be  spoken  of  abroad,  I  vtdll  not  dviulge  as  reckoning 
that  all  such  should  be  kept  secret. 

While  I  continue  to  keep  this  oath  unviolated,  may 
it  be  granted  to  me  to  enjoy  life  and  practice  of  the  Art 
respected  by  all  men  in  all  times.  But  should  I  tres- 
pass and  violate  this  oath  may  the  reverse  be  my  lot. 

A  Modern  Code  of  Ethics. 

The  great  principles  upon  which  Medical  Ethics  are 
based  are  these : 

The  great  end  and  object  of  the  physician's  efforts 
should  be  "the  greatest  good  to  the  patient." 

The  rule  of  conduct  of  physician  and  patient,  and  of 
physicians  toward  each  other  should  be  the  Golden  Rule: 
"  As  ye  would  that  men  should  do  to  you,  do  ye  also  to 
them  likewise.'' 

The  various  articles  of  the  code  are  only  special  ap- 
plications of  these  great  principles. 

The  physician  should  hold  himself  in  constant  readi- 
ness to  obey  the  calls  of  the  sick.  He  should  ever  bear 
in  mind  the  sacred  character  of  his  calling  and  the  great 
responsibility  which  it  involves,  and  should  remember 
that  the  comfort,  the  health  and  the  lives  of  his  patients 


166  Medicine  as  a  Profession". 

depend  upon  the  skill,  attention  and  faithfulness  with 
which  he  performs  his  professional  duties. 

The  physician,  in  order  that  he  may  be  able  to  ex- 
ercise his  vocation  to  the  best  advantage  of  the  patient, 
should  possess  his  respect  and  confidence.  These  must 
be  acquired  and  retained  by  faithful  attention  to  his 
malady,  by  indulgent  tenderness  towards  the  weakness 
incident  to  his  condition,  and  by  the  exercise  of  a  firm 
but  kindly  authority.  The  physician  is  bound  to  keep 
secret  whatever  he  may  either  hear  or  observe,  while 
in  the  discharge  of  his  professional  duties,  respecting 
the  private  affairs  of  the  patient  or  his  family.  And 
this  obligation  is  not  limited  to  the  period  during  which 
the  physician  is  in  attendance  on  the  patient.  The 
patient  should  be  made  to  feel  that  he  has,  in  his  physi- 
cian, a  friend  who  will  guard  his  secrets  with  scrupu- 
lous honor  and  fidelity. 

The  physician  should  visit  his  patient  as  often  as 
may  be  necessary  to  enable  him  to  acquire  and  keep  a 
full  knowledge  of  the  nature,  progress,  changes  and 
complications  of  the  disease,  and  to  do  for  the  patient 
the  utmost  of  good  that  he  is  able.  But  he  should  care- 
fully avoid  making  unnecessary  visits,  lest  he  render 
the  patient  needlessly  anxious  about  his  case,  or  expose 
himself  to  the  charge  of  being  actuated  by  mercenary 
motives. 

The  physician  should  not  give  expression  to  gloomy 
forebodings  respecting  the  patient's  disease,  nor  mag- 
nify the  gravity  of  the  case.  Bearing  in  mind  the  almost 
infinite  resources  of  nature,  he  should  be  cheerful  and 
hopeful,  both  in  mind  and  manner.  This  will  enable 
him  the  better  to  exercise  his  faculties  and  apply  his 
knowledge  for  the  patient's  benefit,  and  will  inspire  the 


The  Code  of  Medical  Ethics.  167 

patient  with  confidence,  courage  and  fortitude,  which 
are  the  physician's  best  moral  adjutants. 

But  it  is  the  physician's  duty  to  state  the  true  nature 
and  prospects  of  the  case,  from  time  to  time,  to  some 
judicious  friend  or  relative  of  the  patient,  and  to  keep 
this  person  fully  informed  of  its  changes  and  probable 
issue;  and  if  the  patient  himself  requests  the  physician 
to  disclose  to  him  the  nature  and  progress  of  his  disease, 
it  is  his  duty  to  state  tenderly  but  frankly  the  whole 
truth — provided  the  patient  be  of  sound  mind,  and 
strong  enough  to  receive  the  disclosure  without  serious 
injury.  The  patient  has  a  right  to  know  the  truth.  If, 
moreover,  facts  within  the  physician's  knowledge  lead 
him  to  believe  that  it  is  of  great  importance,  in  relation 
to  the  patient's  affairs,  that  he  should  be  warned  of  the 
approach  of  death,  it  is  the  physician's  duty  to  reveal  to 
the  patient's  nearest  friend,  or  to  the  patient  himself, 
the  true  state  of  the  case,  and  the  importance  of  timely 
action. 

Whether  the  case  proceed  favorably,  or  become  mani- 
festly incurable,  it  is  the  physician's  duty  to  continue 
his  attendance  faithfully  and  conscientiously  as  long 
as  the  patient  may  desire  it.  He  is  not  justified  in 
abandoning  a  case  merely  because  he  supposes  it  in- 
curable. 

As  the  patient  has  an  undoubted  right  to  dismiss  his 
physician  for  reasons  satisfactory  to  himself,  so  likewise, 
the  physician  may,  with  equal  propriety,  decline  to  at- 
tend patients,  when  his  self-respect  or  dignity  seem  to 
him  to  require  this  step;  as,  for  example,  when  he  per- 
sistently refuses  to  comply  with  his  directions. 

In  difficult  or  protracted  cases,  consultations  are  ad- 
visable.    They  tend  to  increase  the  knowledge,  energy 
12 


168  Medicine  as  a  Profession. 

and  confidence  of  the  physician,  and  to  maintain  the 
courage  of  the  patient.  The  physician  should  be  ready 
to  act  upon  any  desire  which  the  patient  may  express 
for  a  consultation,  even  though  he  may  not  himself  feel 
the  need  of  it.  Nothing  is  so  likely  to  maintain  the 
patient's  confidence  as  alacrity  in  this  respect.  More- 
over, such  a  course  is  but  just  to  him,  for  he  has  an  in- 
disputable right  to  whatever  aid  or  counsel  he  may  think 
likely  to  be  of  service  to  him. 

The  intimate  relations  into  which  the  physician  is 
brought  with  his  patient  give  him  opportunity  to  ex- 
ercise a  powerful  moral  influence  over  him.  This  should 
always  be  exerted  to  turn  him  from  a  dangerous  or 
vicious  course  towards  a  temperate  and  virtuous  life. 
The  physician  is  sometimes  called  to  assist  in  practices 
of  questionable  propriety,  and  even  of  a  criminal  char- 
acter. Among  these  may  be  mentioned  the  pretence  of 
disease,  in  order  to  evade  services  demanded  by  law, 
as  jury  or  military  duty;  the  concealment  of  organic 
disease  or  of  morbid  tendencies,  in  order  to  secure 
favorable  rates  of  life  insurance,  or  for  deception  of 
other  kinds;  and  especially  the  procurement  of  abor- 
tion when  not  necessary  to  save  the  life  of  the  mother. 
To  all  such  propositions,  the  physician  should  present 
an  inflexible  opposition.  It  is  his  duty,  in  an  authorita- 
tive, but  friendly  manner,  to  explain  and  urge  the 
nature,  illegality  and  guilt  of  the  proposed  action,  and 
to  use  every  effort  to  dissuade  from  it,  and  to  strengthen 
the  patient's  virtue  and  sense  of  right.  The  physician 
should  be  aware  of  the  frequency  of  criminal  abortion, 
and  of  the  different  methods  employed  for  it,  and  should 
take  every  occasion  to  warn  those  who  may  be  tempted 
to  resort  to  it.    In  no  case  should  the  physician  induce 


The  Code  of  Medical  Ethics.  169 

abortion,  or  premature  labor,  without  a  previous  con- 
sultation with  the  most  experienced  practitioners  at- 
tainable, nor  without  the  most  clear  and  imperative 
reasons. 

Physicians  are  required,  by  the  nature  of  their  pro- 
fession, to  sacrifice  comfort,  ease  and  even  health  for 
the  sake  of  their  patients.  Patients  should  reflect  upon 
this,  and  should  understand  and  remember  that  they 
have  corresponding  duties  and  obligations  towards  their 
physicians. 

The  patient  should  select  a  physician  in  whose  knowl- 
edge, skill  and  fidelity  he  can  place  implicit  confidence ; 
whose  habits  of  life  are  regular  and  temperate,  and 
whose  character  and  demeanor  are  such  that  he  can  re- 
gard him  as  a  personal  friend.  He  must  be  able  to 
confide  in  him  freely.  And  the  physician  should  not  be 
changed  for  light  reasons.  A  physician  thoroughly  ac- 
quainted with  the  constitutions,  temperaments  and 
tendencies  of  a  family,  can  the  more  successfully  treat 
the  members. 

The  patient  should  always  consult  his  physician  as 
early  as  possible  after  he  has  discovered  that  he  is  ill. 
A  disease  which  is  trifling  at  its  onset  may  grow  for- 
midable through  neglect.  The  physician  should  be  re- 
garded as  a  confldential  adviser,  who,  on  being  early 
consulted,  may  prevent  a  sickness. 

The  patient  should  faithfully  and  unreservedly  state 
to  his  physician  the  cause  of  his  malady,  and  tell  him 
everything  that  may  have  a  bearing  upon  its  nature. 
Since  the  physician  is  under  the  strongest  obligations 
to  secrecy,  the  patients  should  not  allow  considerations 
of  delicacy,  modesty  or  pride,  to  prevent  an  entirely 


170  Medicine  as  a  Profession. 

frank  statement  of  his  case,  and  candid  and  full  replies 
to  interrogatories. 

The  patient  should  implicitly  obey  his  physician's 
injunctions  as  regards  diet,  regimen  and  medical  treat- 
ment. If  he  deviates  from  these  directions,  he  cannot 
hold  the  physician  to  a  full  responsibility  in  the  case; 
and,  further,  by  a  partial  obedience  he  incurs  some  per- 
sonal risk,  since,  in  the  treatment  of  diseases,  all  parts 
of  the  physician's  advice  are  made  to  harmonize,  and 
each  is  dependent  oh  the  others  and  may  be  unsafe 
without  the  coincidence  of  the  others.  Moreover,  he 
does  the  physician  an  undeserved,  and  often  a  serious 
wrong.  If  the  patient  have  not  sufficient  confidence  in 
his  physician,  and  respect  for  him,  to  follow  his  direc- 
tions, it  were  better  for  him  frankly  to  say  so,  and  to 
employ  another  in  whom  he  can  confide. 

The  patient  should  never  allow  himself,  while  under 
a  physician's  treatment,  to  take  other  medicines  than 
those  prescribed  by  him.  He  would,  by  so  doing,  incur 
a  serious  risk  of  taking  medicines  that  are  incompatible 
with  each  other.  If  desirous  of  trying  any  other  mode 
of  treatment,  it  would  be  much  better  frankly  to  state 
the  fact  to  his  physician  and  ask  his  advice. 

The  patient  should,  if  possible,  avoid  receiving  the 
friendly  visits  of  a  physician  other  than  the  one  under 
whose  charge  he  is.  When  he  receives  such  visits,  he 
should  avoid  conversation  on  the  subject  of  his  disease ; 
for  an  accidental  observation  might  give  him  false  im- 
pressions respecting  his  disease,  or  destroy  his  con- 
fidence in  the  treatment  he  is  pursuing.  He  should 
never  send  for  a  consulting  physician  without  the  ex- 
press consent  of  his  own  medical  attendant;  for  physi- 
cians can  act  together  for  the  advantage  of  their  patient, 


The  Code  of  Medical  Ethics.  171 

only  when  they  act  harmoniously.  Nor  should  he,  by  a 
secret  appointment,  constrain  his  medical  attendant  to 
meet  another  physician  with  whom  he  might  not  be 
willing  to  consult;  but  the  patient  has  an  undoubted 
right  to  have  the  opinion  of  any  physician  whom  he 
may  desire,  upon  his  case.  His  proper  course  is  to  re- 
quest his  medical  attendant  to  arrange  a  consultation, 
and  frankly  state  his  desire  for  the  physician  whom  he 
may  prefer.  If  his  medical  attendant  decline  the  con- 
sultation, it  is  then  for  the  patient  to  determine  whether 
he  will  insist,  and  thus  dismiss  his  medical  attendant, 
or  whether  he  will  defer  to  the  judgment  of  his  own 
physician.    The  patient  has  a  right  thus  to  choose. 

If  the  patient  wishes  to  dismiss  his  physician,  he 
should,  in  justice  and  in  common  courtesy,  state  his 
reasons,  and,  if  possible,  in  a  friendly  manner.  To  dis- 
pense with  the  service  of  a  physician  need  not,  of  neces- 
sity, change  the  social  relations  of  the  parties. 

The  patient  should,  when  practicable,  send  for  the 
physician  in  the  morning,  before  his  usual  hour  for 
leaving  home.  He  will,  by  so  doing,  secure  his  earlier 
attendance,  and  will  enable  him  the  better  to  apportion 
his  time  so  as  to  do  justice  to  all  his  calls  and  engage- 
ments. He  should  call  on  his  physician  during  his 
office  hours  only,  and  should  avoid  disturbing  him  in 
hours  devoted  to  meals,  rest  and  sleep.  In  receiving  his 
physician's  visits,  he  should  avoid  compelling  him  to 
wait,  even  a  few  minutes.  The  aggregate  of  petty  de- 
tentions, while  the  patient  is  making  some  needless 
preparation  to  receive  the  physician,  amounts  to  a  serious 
waste  of  valuable  time. 

Inasmuch  as  every  member  of  the  medical  profession 


172  Medicine  as  a  Profession. 

partakes  of  the  honor  in  which  it  is  held,  is  entitled  to 
its  privileges  and  immunities,  and  profits  by  the  scien- 
tific labors  of  his  predecessors  and  associates,  it  is  his 
duty  faithfully  to  endeavor,  in  his  turn,  to  elevate  the 
position  of  the  profession  and,  by  every  honorable  ex- 
ertion, to  enrich  the  science  of  medicine. 

In  no  other  profession  should  a  higher  standard  of 
morality  and  greater  purity  of  personal  character  be 
required.  Physicians  ought  to  come  up  to  this  standard, 
and  do  what  they  may  to  exalt  it.  As  the  practice  of 
medicine  requires  the  constant  exercise  of  a  vigorous 
and  clear  understanding,  and  as  the  practitioner  should 
be,  at  all  times,  ready  for  emergencies  in  which  the  wel- 
fare and  even  the  life  of  a  fellow  creature  may  de- 
pend upon  his  steady  hand,  acute  eye  and  unclouded 
brain,  it  is  incumbent  upon  the  physician  to  be  tem- 
perate in  all  things. 

The  physician  should  not  resort  to  public  advertise- 
ments, or  private  cards  or  handbills,  inviting  the  atten- 
tion of  persons  affected  by  particular  disease,  or  pub- 
licly offering  advice  and  medicine  to  the  poor,  gratis,  or 
promising  radical  cures.  Neither  should  he  publish 
cases  or  operations  in  the  daily  prints;  nor  invite  lay- 
men to  be  present  at  operations,  nor  solicit  or  exhibit 
certificates  of  skill  and  success ;  nor  perform  any  similar 
act. 

It  is- equally  derogatory  tp  prof^sional  character  for 
a  physician  to  hold  a  pa^ifm  for  any  nostrum  or  any 
surgical  instrument  or  appliance;  or  to  keep  secret  the 
nature  and  composition  of  any  medicine  used  by  him. 
Such  restriction  or  concealment  is  inconsistent  with 
the  beneficence  and  liberality  which  should  characterize 
the  medical  profession.    But  it  is  the  duty  of  the  physi- 


The  Code  of  Medical  Ethics.  173 

cian  to  avail  himself  of  every  opportunity  to  observe  the 
action  and  study  the  properties  of  new  or  secret  rem- 
edies, and  new  processes  of  preparing  medicines,  as 
well  as  new  modes  of  treating  diseases,  and  to  subject 
them  to  the  analysis  of  scientific  investigation.  For  the 
physician  should  always  bear  in  mind  that  the  great 
object  of  his  profession  is  to  cure  the  sick,  and  that  it 
is  not  only  admissible,  but  is  his  solemn  duty  to  inves- 
tigate, thoroughly  and  without  prejudice,  whatever 
offers  any  probability  of  adding  to  his  knowledge  of  the 
art  and  means  of  curing,  and  of  thus  enriching  the 
science  of  medicine. 

All  practitioners  of  medicine,  their  wives,  and  chil- 
dren while  under  the  parental  care,  are  entitled  to  the 
gratuitous  services  of  any  one  or  more  of  the  faculty 
residing  near  them.  Physicians,  when  ill,  are  incom- 
petent to  prescribe  for  themselves.  The  natural  anxiety 
and  solicitude  which  they  feel  for  members  of  their  own 
family  when  ill,  tend  to  obscure  their  professional  judg- 
ment and  make  it  difficult  to  treat  them.  Under  these 
circumstances,  physicians  are  peculiarly  dependent  on 
each  other;  kind  offices  and  professional  aid  should  al- 
ways be  cheerfully  and  gratuitously  afforded.  But  visits 
should  not  be  obtruded,  officiously  or  unasked,  upon  a 
sick  physician. 

If,  however,  a  physician,  in  affluent  circumstances, 
request  the  attendance  of  a  distant  professional  brother, 
■  and  offer  an  honorarium,  it  is  not  proper  to  decline  it ; 
for  one  should  not,  even  from  a  kindly  motive,  impose 
upon  another  a  pecuniary  obligation,  which  the  re- 
cipient would  not  wish  to  incur. 

If  a  physician  is  called  from  any  considerable  dis- 
tance,  the   expense   of   travel,   etc.,   thereby  incurred, 


174  Medicine  as  a  Profession. 

should  always  be  paid  by  the  physician  receiving  the 
visit,  and  an  honorarium  may  be  tendered  if  much  time 
is  consumed  in  making  the  visit. 

Attention  to  his  personal  affairs,  the  pursuit  of  health 
and  the  various  contingencies  to  which  the  physician  is 
peculiarly  exposed,  sometimes  compel  him  temporarily 
to  withdraw  from  his  duties  to  his  patients,  and  request 
some  of  his  professional  brethren  to  discharge  them  for 
him.  Compliance  with  such  a  request  is  an  act  of 
courtesy  which  should  always  be  performed  with  the 
utmost  consideration  for  the  interests  and  character  of 
the  physician  relieved.  When  this  is  done  for  a  short 
period  only,  all  the  pecuniary  obligations  for  such  serv- 
ices should  belong  to  him.  But  if  a  physician  neglect 
his  business  in  quest  of  amusement  and  pleasure,  he  is 
not  entitled  to  the  frequent  and  long-continued  exercise 
of  his  fraternal  courtesy  without  conceding  to  the  physi- 
cian who  acts  for  him  the  fees  accruing  from  the  duties 
discharged  by  the  latter. 

Obstetrical  and  surgical  cases  involve  unusual  fatigue 
and  responsibility;  and  it  is  just  that  the  fees  accruing 
therefrom  should  belong  to  the  physician  who  attends 
them. 

A  complete  medical  education,  of  which  the  diploma 
of  a  medical  college  is  the  formal  voucher,  furnishes  the 
only  presumptive  evidence  of  professional  acquirements 
and  abilities.  But  the  annals  of  the  profession  contain 
the  names  of  some  who,  not  having  the  advantage  of  a 
complete  medical  education,  became,  nevertheless, 
through  their  own  exertions  and  abilities,  brilliant 
scholars  and  successful  practitioners.     A  practitioner, 


The  Code  of  Medical  Ethics.  175 

therefore,  whatever  his  credentials  may  be,  who  enjoys 
a  good  moral  and  professional  standing  in  the  com- 
munity, should  not  be  excluded  from  fellowship,  nor  his 
aid  rejected,  when  it  is  desired  by  the  patient  in  con- 
sultation. No  difference  in  views  on  subjects  of  medical 
principles  or  practice  should  be  allowed  to  influence  a 
physician  against  consenting  to  a  consultation  with  a 
fellow  practitioner.  The  very  object  of  consultation  is 
to  bring  together  those  who  may,  perhaps,  differ  in  their 
views  of  the  disease  and  its  appropriate  treatment,  in 
the  hope  that  from  a  comparison  of  different  views  may 
be  derived  a  just  estimate  of  the  disease  and  a  success- 
ful course  of  treatment. 

No  test  of  orthodoxy  in  medical  practice  should  be 
applied  to  limit  the  freedom  of  consultation.  Medicine 
is  a  progressive  science.  Its  history  shows  that  what 
is  heresy  in  one  century  may,  and  probably  will  be 
orthodoxy  in  the  next.  No  greater  misfortune  can 
befall  the  medical  profession  than  the  action  of  an  in- 
fluential association  or  academy  establishing  a  creed  or 
standard  of  orthodoxy  or  ^^  regularity."  It  will  be  fatal 
to  freedom  and  progress  in  opinion  and  practice.  On 
the  other  hand,  nothing  will  stimulate  the  healthy 
growth  of  the  profession,  both  in  scientific  strength  and 
in  the  honorable  estimation  of  the  public,  as  the  uni- 
versal and  sincere  adoption  of  a  platform  which  shall 
recognize  and  guarantee:  a  truly  fraternal  good- will 
and  fellowship  among  all  who  devote  themselves  to  the 
care  of  the  sick;  a  thorough  and  complete  knowledge, 
however  obtained,  of  all  the  direct  and  collateral 
branches  of  medical  science — as  it  exists  in  all  sects  and 
schools  of  medicine — as  the  essential  qualification  of  a 
physician;  perfect  freedom  of  opinion  and  practice,  as 


176  Medicine  as  a  Profession. 

the  unquestionable  prerogative  of  the  practitioner,  who 
is  the  sole  judge  of  what  is  the  hest  mode  of  treatment 
in  each  case  of  sickness  entrusted  to  his  care. 

The  physician  may,  with  propriety,  decline  to  meet 
a  practitioner  of  whose  inimical  feelings  towards  him- 
self, or  of  whose  general  unfairness  in  consultations  he 
is  satisfied.  But,  in  such  a  case,  he  should  explain  to 
the  patient  his  reasons;  and  if  the  patient  desire  the 
the  opinion  of  the  practitioner  objected  to,  the  family 
physician  may  withdraw  from  the  case  and  allow  the 
other  to  be  sent  for.  But,  in  justice  to  the  latter,  the 
state  of  affairs  should  be  explained  to  him  at  the  time 
he  is  requested  to  visit  the  patient. 

The  utmost  punctuality  should  be  observed  in  the 
visits  of  physicians  when  they  are  to  hold  consultations 
together;  this  is  generally  practicable,  for  society  allows 
the  plea  of  professional  engagements  to  excuse  the 
neglect  of  all  others,  and  to  be  a  valid  reason  for  the  re- 
linquishment of  any  present  occupation.  But,  as  pro- 
fessional engagements  may  sometimes  interfere  and  de- 
lay one  of  the  parties,  the  physician  who  first  arrives 
should  wait  for  his  associate  a  reasonable  period  of  time, 
after  which  the  consultation  should  be  considered  post- 
poned to  a  new  appointment.  If  it  be  the  attending 
physician  who  is  present,  he  will,  of  course,  see  the 
patient  and  prescribe ;  but  if  it  be  the  consulting  physi- 
cian, he  should  retire  without  seeing  the  patient,  except 
in  cases  of  emergency,  or  when  he  has  been  called  from 
a  considerable  distance,  in  which  case  he  may  examine 
the  patient,  and  give  his  opinion  in  writing  and  under 
seal,  to  be  delivered  to  the  attending  physician. 

In  consultations,  no  rivalry  or  jealousy  should  be 
indulged  in.    Candor,  probity  and  all  due  respect  should 


The  Code  of  Medical  Ethics.  177 

be  exercised  towards  the  physician  in  charge  of  the  case. 
If  the  consulting  physician  cannot  agree  with  him 
respecting  the  nature  and  proper  treatment  of  the  case, 
the  physician  should  state  this  fact  to  the  patient,  or 
his  nearest  friend,  both  physicians  being  present  at  the 
time,  and  should  request  him  to  select  the  one  in  whom 
he  has  most  confidence.  But,  if  they  agree  sufficiently 
to  take  joint  charge  of  the  case,  then  the  consulting 
physician  must  justify  and  uphold,  so  far  as  he  can  con- 
scientiously do  so,  the  practice  of  his  associate,  and  must 
abstain  from  any  hints,  insinuations  or  actions  which 
might,  in  any  way,  impair  the  confidence  which  the 
patient  reposes  in  him,  or  affect  his  reputation.  He 
must  refrain  from  any  extraordinary  attentions  or  as- 
siduities, calculated  to  ingratiate  himself  in  the  patient's 
favor  and  to  supplant  his  associate. 

In  consultations,  the  attending  physician  should  first 
put  the  necessary  question  to  the  patient.  After  this, 
the  consulting  physician  should  make  such  additional 
inquiries  and  examinations  as  may  be  needed  to  satisfy 
him  of  the  true  nature  of  the  case.  But  he  should  avoid 
making  a  parade  of  examining  the  patient  more  thor- 
oughly than  had  been  done  before ;  rather  suggesting  to 
the  attending  physician,  where  this  is  possible,  to  make 
whatever  examinations  he  desires,  than  making  them 
himself.  Both  physicians  should  then  retire  to  a  private 
room  for  deliberation. 

In  consultations,  the  attending  physician  should  de- 
liver his  opinion  first;  then,  where  there  are  several 
consulting  physicians,  they  should  express  their  opin- 
ions in  the  order  in  which  they  have  been  called  in. 
Should  an  irreconcilable  diversity  of  opinion  occur, 
when  more  than  two  physicians  meet  in  consultation. 


178  Medicine  as  a  Profession". 

the  opinion  of  the  majority  should  be  regarded  as  de- 
cisive; but,  if  the  number  be  equal  on  each  side,  the  de- 
cision should  rest  with  the  attending  physician.  If  two 
physicians,  in  consultation,  cannot  agree,  they  should 
call  in  a  third  to  act  as  umpire.  If  this  is  not  prac- 
ticable, the  patient  must  be  requested  to  select  the  physi- 
cian in  whom  he  is  most  willing  to  confide.  The  physi- 
cian who  is  left  in  the  minority  should,  without  any  ill 
feeling,  retire  from  the  consultation,  and  from  any 
further  participation  in  the  management  of  the  case; 
and,  in  justice  to  the  physician  thus  retiring,  the  fact 
of  his  difference  from  his  associates  should,  in  the  pres- 
ence of  all  the  physicians  attending,  be  explained  to  the 
patient,  as  his  reason  for  withdrawing  from  the  case. 

The  attending  physician  should  communicate  to  the 
patient  or  his  friends  the  directions  agreed  upon  in  the 
consultation,  as  well  as  any  opinon  which  it  may  be 
thought  proper  to  express.  But  no  statement  or  discus- 
sion should  take  place  before  the  patient  or  his  friend, 
except  in  the  presence  of  all  the  physicians  attending, 
and  by  their  common  consent.  And  no  opinions  or  prog- 
nostications should  be  delivered,  which  are  not  the  re- 
sult of  previous  deliberation  and  concurrence.  No  de- 
cision arrived  at  in  a  consultation  is  to  be  regarded  as 
restraining  the  attending  physician  from  making  such 
variations  in  the  treatment  as  any  subsequent  change  in 
the  case  may  demand.  But  such  variation  and  the  rea- 
sons for  it  ought  to  be  carefully  noted  at  the  time,  and 
detailed  at  the  next  meeting  in  consultation.  The  same 
privilege  belongs  also  to  the  consulting  physician,  if  he 
is  sent  for  in  an  emergency  when  the  attending  physi- 
cian is  out  of  the  way;  and  similar  explanations  must 
be  made  by  him  at  the  next  meeting. 


The  Code  of  Medical  Ethics.  179 

Sometimes  a  special  consultation  is  desirable  in  cases 
in  which  the  continued  attendance  of  two  physicians 
might  be  objectionable  to  the  patient.  The  consulting 
physician,  in  such  a  case,  should  sedulously  avoid  all 
further  unsolicited  attendance.  Such  consultation  re- 
quires an  extraordinary  outlay  of  time  and  attention, 
and  at  least  a  double  honorarium  may  be  reasonably  ex- 
pected. 

The  consulting  physician  cannot,  with  propriety,  take 
exclusive  charge,  at  any  time,  of  the  patient  in  whose 
case  he  has  been  called  in  consultation,  without  the  con- 
sent of  the  attending  physician,  except  in  cases  herein 
provided  for. 

Medicine  is  a  liberal  profession  and  those  admitted 
into  its  ranks  should  base  their  expectations  of  success 
upon  the  extent  of  their  qualifications,  not  upon  in- 
trigue or  artifice.  A  physician  should  not  allow  him- 
self to  feel  envious  or  jealous  of  a  brother  practitioner. 
The  distinction  which  one  successful  physician  wins  is 
shared  by  the  whole  profession.  Nor  should  a  physician 
suffer  himself  to  feel  ill-will  towards  another  who  may 
come  into  his  neighborhood  and  appear  likely  to  take  a 
share  of  the  business  which  he  has  hitherto  enjoyed. 
Such  feelings  are  inconsistent  with  the  beneficent  and 
liberal  nature  of  the  profession.  Liberality  and  true 
generous  fraternity  in  thought,  word  and  deed,  will 
unite  the  interests  of  all  the  members  of  the  profession, 
and  will  so  exalt  the  estimation  in  which  it  is  held  in 
the  community  that,  confidence  being  increased,  busi- 
ness will  likewise  increase ;  and  to  physicians  will  be  ac- 
corded the  position  which,  of  right,  should  be  theirs; 
that  of  confidential  family  advisers  in  all  matters  per- 


180  Medicine  as  a  Profession. 

taining  to  the  care  of  the  body  in  health,  no  less  than 
in  sickness. 

The  physician,  in  his  intercourse  with  a  patient  who 
is  under  the  care  of  another  practitioner,  should  observe 
the  strictest  caution  and  reserve.  No  meddling  ques- 
tions should  be  asked  in  any  interview  for  business  or 
friendship,  no  disingenuous  hints  thrown  out  relating 
to  the  nature  and  treatment  of  his  disorder;  nor  should 
the  patient  be  allowed  to  converse  upon  these  topics.  No 
course  of  conduct  should  be  pursued  which  might,  di- 
rectly or  indirectly,  tend  to  diminish  the  trust  reposed 
in  the  physician  employed. 

A  physician  should  not  take  charge  of  a  patient  who 
is,  or  has  recently  been,  under  the  charge  of  another 
practitioner  in  the  same  illness,  except  in  cases  of  sud- 
den emergency,  or  in  consultation  with  the  physician 
previously  in  attendance,  or  when  the  latter  has  relin- 
quished the  case,  or  has  been  regularly  notified  that  his 
services  are  no  longer  required.  Under  such  circum- 
stances no  unjust  or  illiberal  remarks  should  be  made, 
or  insinuations  thrown  out  in  relation  to  the  treatment 
pursued  by  the  previous  physician.  Nor  should  the 
physician  permit  the  patient  unreasonably  to  find  fault 
with  his  predecessor.  For  patients  often  become  dis- 
satisfied with  their  attendant  on  account  of  the  mere 
duration  of  a  case  which  no  degree  of  professional 
knowledge  or  skill  could  have  shortened. 

In  cases  of  accident  or  sudden  emergency,  one  or 
more  physicians  are  often  sent  for  by  alarmed  friends. 
Courtesy  should  assign  the  patient  to  the  first  of  these 
that  arrives;  and  he  should  select  from  those  present 
such  additional  assistance  as  he  may  deem  necessary. 
But  he  should  also  request  the  family  physician   (if 


The  Code  of  Medical  Ethics.  181 

there  be  one)  to  be  sent  for,  and,  on  his  arrival,  resign 
the  case  into  his  hands.  The  practitioner  of  the  patient, 
when  he  arrives,  should  take  the  place  of  any  one  called 
in  his  absence.  "The  practitioner  of  any  patient'' 
is  the  man  whom  he  has  in  any  way  given  to  under- 
stand that  he  regards  him  as  his  medical  adviser,  or 
who  would  now  be  in  charge  of  the  case  were  it  not  for 
his  absence,  sickness  or  other  disability. 

In  a  sparse  population,  a  physician  when  visiting  a 
sick  person  may  be  desired  to  see,  in  an  emergency,  a 
neighboring  patient,  who  is  under  the  regular  charge  of 
another  physician.  The  conduct  to  be  pursued  on  such 
an  occasion  is :  to  give  advice  adapted  to  present  circum- 
stances; to  interfere  as  little  as  possible  with  the  gen- 
eral plan  of  treatment;  to  assume  no  further  direction 
of  the  case  unless  it  be  expressly  desired;  and,  in  the 
latter  case,  to  request  an  immediate  consultation  with 
the  practitioner  previously  employed. 

A  wealthy  physician  should  not  give  advice  gratis  to 
the  affluent;  because  his  so  doing  is  an  injury  to  his 
professional  brethren.  The  office  of  the  physician  can 
never  be  supported  as  an  exclusively  beneficent  one ;  and 
it  is  defrauding,  in  some  degree,  the  common  fund, 
when  fees  are  dispensed  with,  which  might  justly  be 
claimed. 

When  a  physician  who  has  been  engaged  to  attend  a 
case  of  midwifery  is  absent  and  another  is  sent  for,  if 
delivery  is  accomplished  in  the  absence  of  the  former, 
the  latter  is  entitled  to  the  fee,  but  he  should  resign  the 
patient  to  the  practitioner  first  engaged. 

Diversity  of  opinion  and  opposition  of  interests  may, 
in  the  medical,  as  in  other  professions,  sometimes  occa- 


182  Medicine  as  a  Peofessioit. 

sion  controversy  and  even  contention.  When  such  cases 
occur  and  cannot  be  immediately  terminated,  they 
should  be  referred  to  the  arbitration  of  a  sufficient  num- 
ber of  physicians  or  a  court-medical. 

Some  general  rules  should  be  adopted  by  the  physi- 
cians in  every  town  or  district,  relative  to  pecuniary  ac- 
knowledgments from  patients.  These  should  be  ad- 
hered to  by  physicians  as  uniformly  as  circumstances 
will  permit.  They  serve,  likewise,  as  a  standard  to  which 
appeal  may  be  taken  in  cases  of  doubt  or  dispute. 

Members  of  the  medical  profession  have  been  so  uni- 
formly in  the  habit  of  attending,  gratuitously,  the  in- 
digent sick  and,  in  general,  of  answering  every  call 
promptly,  and  without  a  question  as  to  whether  they  are 
to  receive  remuneration  therefor,  that  many  persons 
seem  to  think  they  have  a  right  to  demand  the  services 
of  physicians;  and  do,  in  fact,  call  upon  them  freely, 
and  neglect  or  refuse  to  render  any  pecuniary  equiva- 
lent, although  abundantly  able  to  do  so.  They  impose 
upon  one  physician,  in  this  way,  until  they  have  ex- 
hausted his  patience,  and  then  call  upon  another;  and 
thus,  in  the  course  of  a  few  years,  make  the  circuit  of 
the  profession  in  their  neighborhood.  It  is  proper  for 
the  physicians  of  a  community  to  make  a  list  of  the  names 
of  such  individuals,  and  to  demand,  before  visiting  those 
whose  names  are  on  it,  adequate  security  that  their 
honorarium  will  be  paid. 

As  good  citizens,  it  is  the  duty  of  physicians  to  be 
vigilant  for  the  welfare  of  the  community,  and  to  bear 
their  part  in  sustaining  its  institutions  and  burdens. 
They  should  be  always  ready  to  give  counsel  to  the  pub- 


The  Code  of  Medical  Ethics.  183 

lie,  in  relation  to  matters  appertaining  to  their  profes- 
sion; as  for  example,  on  subjects  of  medical  police, 
public  hygiene  and  legal  medicine.  It  is  their  province 
to  enlighten  the  public  in  regard  to  quarantine  regu- 
lations, the  location,  arrangement  and  dietaries  of  hos- 
pitals, asylums,  schools,  prisons  and  similar  institutions ; 
in  relation  to  the  medical  police  of  towns,  drainage,  ven- 
tilation, etc.,  and  in  regard  to  measures  for  the  preven- 
tion of  epidemic  and  contagious  disease.  And,  when 
pestilence  prevails,  it  is  their  duty  to  face  the  danger, 
and  to  continue  their  labors  for  the  alleviation  of  suf- 
fering, and  the  saving  of  life,  even  at  the  risk  of  their 
own  lives. 

Physicians  should  always  be  ready,  when  called  on 
by  the  proper  authorities,  to  enlighten  coroners'  inquests 
and  courts  of  justice,  on  matters  strictly  medical,  such 
as  involve  questions  relating  to  insanity,  legitimacy,  or 
sudden  and  violent  deaths,  and  in  regard  to  the  various 
other  subjects  embraced  in  the  science  of  medical  juris- 
prudence. But,  in  these  cases,  and  especially  where 
they  are  required  to  make  post-mortem  examination,  it 
is  just  and  right,  in  consequence  of  the  time,  labor  and 
skill  required,  and  the  responsibility  and  risk  they  in- 
cur, that  the  public  should  award  them  more  than  a 
mere  consulting  fee. 

There  is  no  profession,  by  the  members  of  which 
eleemosynary  services  are  more  freely  dispensed  than 
they  are  by  physicians;  but  justice  demands  that  some 
limits  should  be  placed  to  the  claims  upon  such  offices 
at  their  hands.  Poverty,  professional  brotherhood,  the 
benevolent  and  scantily  remunerated  occupation  of  the 
individual  patient,  should  always  be  recognized  as  pre- 
senting valid  claims  for  gratuitous  services.  But  neither 
13 


184  Medicine  as  a  Profession. 

institutions  endowed  by  the  public  or  by  rich  indi- 
viduals, societies  for  mutual  benefit,  for  the  insurance 
of  lives  or  for  analogous  purposes,  nor  any  profession 
or  occupation  can  be  admitted  to  possess  such  privilege. 
Nor  can  it  be  justly  expected  of  physicians  to  furnish 
certificates  of  inability  to  serve  on  juries,  or  perform 
military  duty,  or  to  certify  to  the  state  of  health  of 
parties  wishing  to  insure  their  lives,  obtain  pensions  or 
the  like,  without  a  pecuniary  acknowledgment.  But  to 
indigent  persons,  such  professional  service  should  al- 
ways be  cheerfully  and  freely  accorded. 

The  benefits  accruing  to  the  public,  directly  and  indi- 
rectly, from  the  Active  and  constant  labors  and  benef- 
icence of  the  medical  profession  are  so  numerous  and 
important  that  physicians  are  justly  entitled  to  the  ut- 
most consideration  from  the  community.  The  public 
ought,  likewise,  to  entertain  a  just  appreciation  of  the 
proper  qualification  of  a  practitioner  of  medicine;  to 
make  a  due  discrimination  between  true  science  and  the 
assumption  of  ignorance  and  empiricism ;  to  afford  every 
encouragement  and  facility  for  the  acquisition  of  med- 
ical education,  and  not  to  allow  the  provisions  of  their 
statute  books  or  of  the  prospectus  of  their  chartered 
institutions  to  interpose  any  obstacle  to  the  attainment 
of  the  fullest  knowledge  of  every  branch  of  medical 
science,  or,  in  any  way,  to  restrain  the  most  entire  free- 
dom of  thought,  investigation  and  action  in  matters  ap- 
pertaining to  the  practice  of  medicine. 


APPENDIX. 


BIBLIOGRAPHY. 

Eeadings  in  the  History  of  Medicine. 

Berdoe,  Edw.  The  Origin  and  Growth  of  the  Healing  Art. 
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Tables. 


193 


Table  Showing  Number  of  Physicians  for  each  100,000  of 
Population  by  States. 


States. 

Number  of  Male 
Physicians. 

Number  of  Fe- 
male Physicians. 

1900. 

1910. 

1900. 

1910. 

Alabama 

116 
105 
180 

201 
260 
243 
155 
151 
315 
126 
120 
126 
189 
204 
166 
190 
165 
110 
165 
170 
169 
168 
109 
149 
221 
141 
145 
176 
195 
133 
104 
177 
90 
94 
192 
179 
183 
154 
144 
89 
115 
181 

113 
120 
119 
169 
190 
204 
127 
123 
349 
120 
110 
116 
162 
150 
140 
142 
135 
123 
162 
163 
161 
143 
113 
107 
194 
160 
154 
154 
207 
107 
139 
157 
87 
98 
159 
152 
163 
154 
127 
80 
111 
167 

1 

12 

3 

3 

40 

32 

14 

4 

20 

4 

2 

9 

17 

8 

12 

13 

4 

2 

9 

7 

27 

11 

11 

1 

9 

7 

12 

15 

15 

9 

3 

12 

1 

5 

10 
7 
20 
9 
13 
1 
6 
2 

1 

Alaska 

0 

Arizona 

3 

Arkansas 

3 

California 

31 

Colorado 

22 

Connecticut 

10 

Delaware 

5 

District  of  Columbia 

31 

Florida 

6 

Georgia 

3 

Idaho 

9 

Illinois 

15 

7 

Iowa. 

11 

9 

Kentucky 

4 

T      •  •     -^ 

2 

Maine 

11 

7 

Massachusetts 

20 

Michigan 

8 

Minnesota 

8 

Mississippi 

2 

Missouri 

10 

Montana 

13 

Nebraska 

10 

New  Hampshire 

15 

Nevada 

15 

New  Jersey 

8 

New  Mexico 

5 

15 

North  Carolina 

2 

4 

Ohio 

9 

Oklahoma 

6 

Oregon 

2 

Pennsylvania 

10 

Rhode  Island 

8 

2 

South  Dakota 

7 

Tennessee 

4 

194 


Medicine  as  a  Profession. 


states. 

Number  of  Male 
Physicians. 

Number  ol  Fe- 
male Physicians. 

1900. 

1910. 

1900. 

1910. 

Texas 

191 

97 
211 
113 
172 
141 
161 
153 

125 
104 
197 
180 
144 
130 
111 
140 

3 

12 
7 
2 

12 
2 
7 

13 

4 

Utah 

13 

Vermont 

9 

Virginia 

2 

Washington 

13 

West  Virginia 

3 

Wisconsin 

6 

Wvoming 

8 

Table    Showing   Number    of    Physicians    per    100,000   of 
Population  in  the  Leading  Cities. 


Cities. 


Number  of  Male 

Number  of  Fe- 

Physicians. 

male  Physicians. 

1900. 

1914. 

1900. 

1914. 

373 

251 

22 

15 

198 

197 

6 

13 

218 

194 

14 

1 

265 

249 

60 

31 

158 

140 

13 

8 

187 

170 

18 

11 

159 

143 

22 

12 

114 

169 

32 

22 

217 

110 

24 

12 

250 

144 

22 

10 

260 

154 

19 

10 

224 

195 

12 

10 

151 

114 

18 

10 

349 

114 

13 

10 

83 

98 

8 

5 

203 

174 

29 

10 

301 

256 

27 

19 

100 

80 

8 

4 

139 

324 

49 

32 

508 

267 

89 

58 

264 

273 

15 

18 

145 

136 

15 

10 

188 

254 

8 

10 

151 

138 

13 

10 

Atlanta 

Albany 

Baltimore 

Boston 

Bridgeport,  Conn, 

Buffalo 

Cambridge,  Mass 

Chicago 

Cincinnati 

Cleveland 

Columbus,  O. . . . , 

Dayton,  O 

Denver 

Detroit 

Fall  River 

Grand  Rapids... 
Indianapolis .... 

Jersey  City 

Kansas  City .... 
Los  Angeles .... 

Louisville 

Lowell 

Memphis 

Milwaukee 


Tables. 


195 


cities. 

Number  of  Male 
Physicians. 

Number  of  Fe- 
male Physicians. 

1900. 

1914. 

1900. 

1914. 

Minneapolis 

222 
320 
196 
123 
190 
330 
271 
116 
101 
117 
297 
176 
210 
196 
233 
187 
321 
138 
291 
280 
242 
236 
316 

197 
273 
159 
175 
138 
189 
257 
115 
198 
169 
241 
165 
187 
166 
228 
174 
210 
128 
230 
200 
206 
208 
300 

54 
10 

17 
26 
14 
60 
45 
7 
19 
20 
63 
19 
14 
25 
18 
17 
51 
13 
21 
25 
37 
23 
12 

24 

Nashville 

18 

New  Haven 

13 

New  Orleans 

5 

New  York 

10 

Oakland 

38 

Omaha 

25 

Paterson 

5 

Philadelphia 

19 

Pittsburg 

9 

Portland 

41 

14 

Richmond 

9 

18 

St.  Louis 

16 

St.  Paul 

15 

San  Francisco 

34 

10 

Seattle 

30 

25 

Syracuse 

20 

Toledo 

14 

Washington 

21 

196 


Medicine  as  a  Profession. 


Statistics  of  Medical  Colleges. 


Name  and  Location  of  College. 


OS 


P 


Med.  Col.,  Birmingham,  Ala 

University  of  Ala.,  Mobile,  Ala 

University  of  Ark.,  Little  Rock 

Col.  of  Physicians  and  Surgeons,  San 
Francisco 

Hahnemann  Med.  Col.,  San  Francisco. 

Leland  Stanford  Junior  Univ.  (a),  San 
Francisco . 

University  of  California,  San  Francisco 

Col.  of  Physicians  and  Surgeons,  Los 
Angeles 

Col.  of  Osteopathic  Physicians  and 
Surgeons,  Los  Angeles 

Col.  of  Med.  and  Surgery,  Oakland, 
Cal 

College  of  Medical  Evangelists,  Loma 
Linda,  Cal 

University  of  Colorado,  Boulder,  Den- 
ver   

Yale  Medical  School,  New  Haven, 
Conn 

George  Washington  University,  Wash- 
ington, D.  C 

Georgetown  University,  Washington, 
D.  C 

Howard  University,  Washington,  D.  C 

Atlanta  Medical  College 

Southern  Col.  of  Med.,  Atlanta,  Ga. . . 

University  of  Georgia,  Augusta,  Ga. . , 

Bennett  Medical  College,  Chicago 

Chicago  Col.  of  Med.  and  Surg.,  Chi- 
cago  

Hahnemann  Med.  Col.  and  Hospital, 
Chicago 

Jenner  Medical  College,  Chicago , 

Northwestern  University  Med.  School, 
Chicago 

Rush  Medical  College  (a),  Chicago. . . . 

College  of  Osteopathy,  Chicago 

University  of  Illinois,  Chicago 


R. 
R. 
R, 

R, 
H 

R 
R. 

R. 

O. 

R, 

R 

R 

R 

R. 


M. 
M. 
M. 

M.F, 
M.F, 

M.F, 
M.F, 

M.F, 

M.F, 

M. 

M.F 

M. 

M. 

M. 


R. 

M.F. 

R. 

M.F. 

R. 

M. 

R. 

M. 

R. 

M.F. 

R. 

M.F. 

R 

H. 

M. 

R. 

M.F. 

R. 

M.F. 

R. 

M. 

0. 

M.F. 

R. 

M.F. 

Tables. 


197 


Name  and  Location  of  College. 


Indiana  University,  Indianapolis- 
Bloomington,  Ind 

State  University  of  Iowa,  Iowa  City,  la. 

Still  Col.  of  Osteopathy,  Des  Moines, 
la.... 

University  of  Kansas,  Kansas  City. .  .  . 

University  of  Louisville,  Louisville,  Ky 

Tulane   University   School   of   Med., 
New  Orleans,  La 

Medical  School  of  Maine,  Portland,  Me 

Col.  of  Physicians  and  Surgeons,  Balti- 
more, Md 

John  Hopkins  University,  Baltimore, 
Md... 

University   of   Maryland,   Baltimore, 
Md 

Boston  University,  Boston,  Mass 

Mass.  Col.  of  Osteopathy,  Cambridge, 
Mass 

College  of  Physicians  and  Surg.,  Bos- 
ton, Mass 

Harvard  Medical  School,  Boston,  Mass 

Tufts  College  Medical  School,  Boston, 
Mass 

Detroit  College  of  Medicine,  Detroit, 
Mich 

University  of  Michigan,  Ann  Arbor, 
Mich 

University  of  Minnesota  (a),  Minne- 
apolis, Minn 

University  of  Mississippi,  Oxford,  Miss 

University  of  Missouri,  Columbia,  Mo 

Kansas  City  Hahnemann  Med.  Col., 
Kansas  City,  Mo 

Eclectic  Medical  University,  Kansas 
City,  Mo 

American  Medical  College,  St.  Louis, 
Mo. 

American  School  of  Osteopathy,  Kirk- 
ville.  Mo 


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2 

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R. 

M.F. 

2 

4 

0. 

M.F. 

3 

R. 

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2 

4 

R. 

M.F. 

1 

4 

R. 

M.F. 

2 

4 

R. 

M.F. 

1 

4 

R. 

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2 

4 

R. 

M.F. 

2 

4 

R. 

M.F. 

1 

4 

H. 

M.F. 

2 

4 

0. 

M.F. 

4 

R. 

M. 

4 

R. 

M. 

2 

4 

R. 

M.F. 

1 

4 

R. 

M.F. 

1 

4 

H. 

M.F. 

2 

4 

R. 

M.F. 

2 

4 

R. 

M. 

2 

2 

R. 

M.F. 

2 

H. 

M.F. 

1 

4 

E. 

M. 

4 

R. 

M.F. 

1 

4 

0. 

M.F. 

4 

460 
200 

450 
300 
610 

750 
450 

525 

800 

710 
535 

600 

410 
445 

620 

465 

359 

600 

207 
120 


400 
550 
600 


198 


Medicine  as  a  Profession. 


Name  and  Location  of  College. 


•Si's 


fee 

.o 

s 


Central  Col.  of  Osteopathy,  Kansas 
City,  Mo 

St.   Louis   Col.   of  Phys.   and  Surg., 
St.  Louis,  Mo 

Washington  University,  St.  Louis,  Mo 

John  A.  Creighton  Med.  Col.,  Omaha, 
Nebr 

University  of  Nebraska,  Omaha,  Nebr 

Cotner  Medical  College,  Omaha,  Nebr 

Dartmouth  Medical  College,  Hanover, 
N.  H 

Albany  Medical  College,  Albany,  N.  Y 

Columbia  University,  New  York  City . 

Cornell  University  Medical  Col.,  New- 
York  City 

rf^rdham  J^nivepsi^~$^^vy*¥ortiiCityi , 

Long  Island  College  Hospital,  Brook- 
lyn, N.  Y 

New  York  Homeopathic   Med.   Col. 
and  Hosp.,  New  York  City 

New  York  Medical  Col.  and  Hosp.  for 
Women,  New  York  City 

University  and  Belle vue  Hosp.  Med. 
Col.,  New  York  City 

Syracuse  University,  Syracuse,  N.  Y. , 

University  of  Buffalo,  Buffalo,  N.  Y. . 

Leonard  Medical  School,  Raleigh,  N.  C. 

University  of   No.   Carolina,   Chapel 
Hill,  N.  C 

North  Carolina  Med.  Col.,  Charlotte, 
N.  C 

School  of  Medicine,  Wake  Forest,  N.  C 

University  of  No.  Dakota,  University, 
No.  Dak 

Cleveland-Pulte  Med.  Col.,  Cleveland, 
Ohio 

Western    Reserve    Univ.,    Cleveland, 
Ohio 

Eclectic  Med.  Col.,  Cincinnati,  Ohio.  . 


O. 

R. 
R. 

R. 
R. 
E. 

R. 
R. 
R. 

R. 


M.F. 

M.F. 
M. 

M.F. 
M.F, 
M.F. 

M. 

M.F. 

M.F. 

M.F. 

-Mr 


2 
1 


M.F 

M. 

F. 

M. 
M. 
M.F. 

M. 

M. 

M.F 

M. 

M.F 

M.F. 

M. 
M.F 


■  j^lil'  Mijj  ' 


Tables. 


199 


Name  and  Location  of  College. 


Ohio-Miami    Med.    Col.,    Cincinnati, 

Ohio 

StarHng-Medical  Col.,  ColumbuR,  Ohio 
Toledo  Medical  Col.,  Toledo,  Ohio.  .  . 
University  of  Oklahoma,  Norman  and 

Oklahoma,  Okla 

University  of  Oregon,  Portland,  Ore. . 
Hahnemann  Med.  Col.  and  Hospital, 

Philadelphia,  Pa 

Jefferson  Med.  Col.,  Philadelphia,  Pa. 
College  of  Osteopathy,  Philadelphia, 

Pa 


O   rf 


Temple  University,  Philadelphia,  Pa.. . 

University  of  Pennsylvania,  Philadel- 
phia, Pa 

Women's  Med.  Col.  of  Pennsylvania, 
Philadelphia,  Pa 

University  of  Pittsburgh,  Pittsburgh, 
Pa 

Medical    College    of    So.     Carolina, 
Charleston,  S.  C 

University  of  So.  Dakota,  Vermilion, 
S.  Dak 

Lincoln  Memorial  University,  Knox- 
ville,  Tenn 

Meharry  Medical  College,  Nashville, 
Tenn 

Vanderbilt  University,  Nashville,  Tenn. 

University    of    Tennessee,    Memphis, 
Tenn 

University  of  West  Tennessee,  Mem- 
phis, Tenn 

Fort  Worth  School  of  Medicine,  Fort 
Worth,  Tex 

University  of  Texas,  Galveston,  Tex. . . 

Baylor  University,  Dallas,  Tex 

Southern  Methodist  University,  Dallas, 
Tex 

University  of  Utah,  Salt  Lake  City, 
Utah 


R. 
R. 
R. 

R. 
R. 

H. 
R. 

O. 
R. 

R. 

R. 

R. 

R. 

R. 

R. 

R. 
R. 

R. 

R. 

R. 
R. 
R. 

R. 

R. 


M.F. 
M.F. 
M. 

M.F. 
M.F. 

M. 
M. 

M.F. 
M.F. 

M. 

F. 

M. 

M. 

M. 

M.F. 

M.F. 
M. 

M.F. 

M. 

M. 

M.F. 

M.F. 

M.F. 

M.F. 


So 


4 

4 
4 

4 
4 

4 
4 

4 
4 

4 

4 

4 

4 

2 

4 

4 
4 

4 

4 

4 
4 
4 

4 

2 


600 
600 
519 

288 
605 

720 
720 

600 
600 

662 

727 

900 

375 

120 

445 

255 
625 

525 

230 

460 
119 
473 

430 

110 


14 


200 


Medicine  as  a  Profession". 


Name  and  Location  of  College. 


« 

I 

i 

♦3 

ll 

o 
o 

1 

a 

< 

« 

CO 

^1 

la 

R. 

M. 

1 

4 

R. 

M. 

2 

4 

R. 

M. 

2 

4 

R. 

M. 

2 

2 

R. 

M.F. 

2 

4 

R. 

M.F. 

2 

4 

R. 

M.F. 

4 

University  of  Vermont  (a),  Burling- 
ton, Vt 

Medical  College  of  Virginia,  Richmond, 
Va... 

University  of  Virginia,  Charlottesville, 
Va... 

West    Virginia    University,    Morgan- 
town,  W.  Va 

Marquette  University,  Milwaukee,  Wis. 

University  of  Wisconsin,  Madison,  Wis. 

University  of  the  Philippine,  Col.  of 
Med.  and  Surg.,  Manila,  P.  I 


585 

686 

560 

100 
635 

308 


Note,  (a)  require  hospital  interneship  before  granting  degree. 
Schools  not  listed  as  to  requirement  of  collegiate  work  for  ad- 
mission accept  certificate  of  approved  high  schools. 

A  number  of  schools  give  a  two  years'  pre-medical  course, 
but  complete  data  is  not  available. 


Scholarships  in  Medical  Colleges. 

This  list  was  compiled  by  the  Journal  of  the  Amer- 
ican Medical  Association  for  1916. 

University  of  Alabama  School  of  Medicme 66 

Leland  Stanford  Junior  University  School  of  Medicine 3 

University  of  California  Medical   School 3 

University  of  Colorado  School  of  Medicine* 1 

Yale  University  School  of  Medicine 2 

Georgetown  University  School  of  Medicine 3 

Atlanta  Medical   College    12 

Hahnemann  Medical  College  and  Hospital  of  Chicago* 6 

Northwestern  University  Medical   School 9 

Rush   Medical   College,   Chicago 6 

University  of  Illinois  College  of  Medicine* 6 

Indiana  University  School  of  Medicine 10 


Tables.  201 

Bowdoin  Medical   School 1 

Johns  Hopkins  University  Medical  Department 6 

University  of  Maryland  School  of  Medicine 6 

Boston  University  School  of  Medicine* 20 

Medical  School  of  Harvard  University,  Boston* 27 

Detroit  College  of  Medicine  and  Surgery 6 

University  of  Minnesota  Medical  School* 1 

University  of  Missouri  School  of  Medicine 1 

Washington  University  Medical   School 1 

Dartmouth  Medical   School 2 

Columbia  University  College  of  Physicians  and  Surgeons 64 

New  York  Medical  College  and  Hospital  for  Women 2 

Syracuse  University  College  of  Medicine 1 

University  and  Bellevue  Hospital  Medical  College 1 

University  of  Buffalo  Department  of  Medicine 1 

University  of  North  Carolina  School  of  Medicine 1 

University  of  Cincinnati  College  of  Medicine 12 

Western  Reserve  University  School  of  Medicine 1 

University  of  Oregon  Department  of  Medicine 3 

Hahnemann  Medical  College  and  Hospital  of  Philadelphia 3 

Jefferson   Medical   College 1 

University  of  Pennsylvania  School  of  Medicine*t 3 

University  of  Pittsburgh  School  of  Medicine 2 

Woman's  Medical  College  of  Pennsylvania 8 

Medical  College  of  the  State  of  South  Carolina 8 

University  of  Tennessee  College  of  Medicine 1 

Vanderbilt  University  Medical  Department 4 

University  of  Texas  Department  of  Medicine* 1 

University  of  "Vermont  College  of  Medicine 9 

Medical  College  of  Virginia 10 

University  of  Virginia  Department  of  Medicine 2 

♦  Have  loan  funds  also, 

t  Has  fifty   or  more  scholarships  for  graduates   of  Philadelphia 
high  schools. 


202 


Medicine  as  a  Profession. 


TABULAR    SUMMARY   OF  MEDICAL   LAWS 


States  and  Ter- 
ritories 


Alabama 

Alaska , 

Arizona 

Arkansas 

California 

Colorado 

Connecticut 

Delaware 

District  Columbia 

Florida 

Georgia 

Idaho 

Illinois 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts.... 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

New  Hampshire 

New  Jersey 

New  Mexico 

New  York 

North  Carolina.. 
North  Dakota  ... 

Ohio 

Oklahoma 

Oregon. 

Pennsylvania.... 
Rhode  Island  .... 
South  Carolina... 
South  Dakota.... 
Tennessee 


•2    tf 


Wi  fi 


Si  n 


P5! 


10 


5(2) 
7 
10 

9 
4 
5 

7 

10(5) 
6 
7 
6 
6 
7 
7 


(5) 


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(3)  (1) 
7 


(2) 


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v.  ^ 

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Gov. 
Gov. 
Gov. 
Gov. 
Gov. 

Gov. 

Gov. 
Gov. 
Gov. 

Gov. 
Gov. 
Gov. 
Gov. 

Gov. 

Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Rege. 

Gov. 
Gov. 
Gov. 


Gov. 
Gov. 
Gov. 


a 


CO 


Semi-annually 

Jan.,  July 

Jan.,  Apr.,  July,  Oct. 

3  annually 

Jan.,  Apr.,  July, Oct. 

July 

Jan.,  Apr.,  July, Oct. 

Semi-annually 

May,  Oct. 

Apr.,  Oct. 

Jan.,  July 
Jan.,  July 
Feb.,  June,  Oct. 
Semi-annually 
Semi-annually 
Mar.,  July,  Nov. 

July 

Oct.,  June 

Jan.,  Apr.,  July, Oct 

Semi-annually 

Apr.,  Oct. 
Feb.,  Aug.,  Nov. 
May,  Nov. 

June,  Oct. 

Jan.,  Apr.,  July,  Oct. 


Jan.,  July 

Jan.,  Apr.,  July, Oct, 


Semi-annually 
Jan.,  Apr.,  July,  Oct. 
June 
Quarterly 


Tables. 


203 


states  and  Ter- 
ritories 


Texas 

Utah 

Verrnont 

Virginia 

Washington.... 
West  Virginia. 

Wisconsin 

Wyoming 


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50 
75 

50 
50 

25 
50 
25 

10 
9 
7 

17 
9 

12 
8 
3 

(3) 

(5) 

(3) 
(3) 

(2) 
(2) 
(2) 

(2) 
(2) 

(2) 

(1) 

6 
6 
4 

4 

Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Gov. 
Gov. 

25 
25 
20 
25 
25 
10 
25 
25 

Semi-annually 
Jan.,  July 


I 

o 

I 
Is 

Is 

o  a 
<o  "3 

M  9 


12 
0 
0 
7 
7 
3 
5 

25 


Full    data   is   not   available    from    some   states   in    which    the    licensing 
power  is  vested  in  boards  of  health. 


A  LIST  OF  INDIAN  SEEVICE   STATIONS. 

Arizona:  Camp  Verde,  Fort  Defiance,  Keams,  Canon,  Leupp, 
Mohave  City,  Parker,  Phoenix,  Sacaton,  San  Carlos,  Supai, 
Cootsdale,  Talklai,  Tuba,  Valentine,  Yuma. 

California:  Altmas,  Banning,  Campo,  Covelo,  Greenville, 
Hoopa,  Pala  Kiverside,  San  Jacinto,  Ysabel. 

Colorado:  Ignacia,  Navajo,  Springs. 

Idaho:  Lapwai,  Eossfork. 

Iowa:  Toledo. 

Kansas:  Horton,  Lawrence. 

Michigan:  Mt.  Pleasant. 

Minnesota:  Cloquet,  Grand  Portage,  Nett  Lake,  Onigum, 
Pipestone,  Eed  Lake,  Tower,  White  Earth,  Browning,  Crow 
Agency,  Harlem,  Jacko,  Lame-Deer,  Poplar. 

Nebraska:  Genoa,  Winnebago. 

Nevada  :  Fallon,  Lovelocks,  McDermitt,  Moapa,  Schurz,  Stew- 
art, Wadsworth. 

New  Mexico:  Albuquerque,  Blackrock,  Crownpoint,  Dulce, 
Mescalero,  Santa  Fe,  Shiprock. 

New  York:  Salamanca. 

North  Carolina:  Cherokee. 

North  Dakota  :  Belcourt,  Bismarck,  Elbowoods,  Fort  Totten, 
Fort  Yates,  Wahpeton. 

Oklahoma:  Auadarko,  Chilocco,  Colony,  Contomnent,  Geary, 
Hammon,  Otoe,  Pawhusha,  Pawnee,  Shawnee,  Stroud,  White 
Eagle,  Wyandotte. 

Oregon:  Chemawa,  Klamath  Agency,  Pendleton,  Siletz, 
Warm  Springs. 

Pennsylvania:  Carlisle. 

South  Dakota:  Canton,  Cheyenne  Agency,  Crow  Creek, 
Flaudreau,  Greenwood,  Pierre,  Pine  Ridge,  Eapid  City,  Eose- 
bud,  Sisseton. 

Utah:   Santa  Clara,  Whiterocks. 

Washington:  Lincoln,  Miles  P.  O.,  Neah  Bay,  Simcoe, 
Tacoma,  Tekva,  Tulalip. 

Wisconsin:  Ashland,  Bayfield,  Carter,  Lac  du  Flambeau, 
Neopit,  Tom  ah,  Wittenberg. 

Wyoming  :  Wind  Eiver. 

204 


A   LIST   OF    SANITAEIUMS    OPEEATED   PEI- 

VATELY,  HAYING  A  CAPACITY  OF  50 

OE  MOEE  PATIENTS. 

Hospitals  and  sanatoriums  employ  all  kinds  of  help;  laborers, 
stenographers  and  care  takers,  male  nurses  and  druggists. 
Positions  are  not  difficult  to  secure  and  the  pay  is  usually  better 
than  for  similar  positions  outside.  Ambitious  persons  who  are  de- 
sirous to  prepare  later  for  medicine  may  secure  valuable  experi- 
ence while  they  are  earning  money  to  pay  for  their  medical  edu- 
cation. Positions  in  public  hospital  are  usually  obtained 
through  civil  service  examinations.  Appointments  to  the  mis- 
cellaneous service  in  private  institutions  are  obtained  by  appli- 
cation to  these  institutions.  A  list  of  such  institutions  is  given 
herewith. 

Castle  Hot  Springs  Hotel  and  Eesort,  Hot  Springs,  Ariz. 
Desert  Inn,  Phoenix,  Ariz. 
Tucson-Arizona  Sanatorium,  Tucson,  Ariz. 
Armstrong  Springs  Sanatorium,  Armstrong,  Ark. 
Eureka  Sanatorium,  Eureka  Springs,  Ark. 
Dale  Sanatorium,  Texarkana,  Ark. 

Arrowhead  Hot  Springs  Health  Eesort,  Arrowhead  Springs,  Cal. 
Gardner  Sanatorium,  Belmont,  Cal. 
California  Sanatorium,  Belmont,  Cal. 
Burke  Sanatorium,  Burke,  Cal. 
Idyllwild  Sanatorium,  Idyllwild,  Cal. 
San  Carlos  Sanatorium,  La  Manda  Park,  Cal. 
Livermore  Sanatorium,  Livermore,  Cal. 
Loma  Linda  Sanatorium,  Loma  Linda,  Cal. 
Long  Beach  Sanatorium,  Long  Beach,  Cal. 
Pottenger  Sanatorium,  Monrovia,  Cal. 
Paradise  Valley  Sanatorium,  National  City,  Cal. 
Acropolis  Sanatorium,  Oakland,  Cal. 
Nauheim  Sanatorium,  Oakland,  Cal. 
Las  Eucinas,  Lamanda  Park,  Pasadena,  Cal. 

205 


206  Medicine  as  a  Peofession. 

Southern  California  Sanatorium,  Lamanda  Park,  Pasadena,  Cal. 

Agnew  Sanatorium,  San  Diego,  Cal. 

Adler  Sanatorium,  San  Francisco,  Cal. 

O 'Conner  Sanatorium,  San  Jose,  Cal. 

St.  Helena  Sanatorium,  Sanatorium,  Cal. 

El  Eeposo  Sanatorium,  Sierra  Madre,  Cal. 

Pasadena  Sanatorium,  South  Pasadena,  Cal. 

Clarks  Sanatorium,  Stockton,  Cal. 

Boulder,  Colorado  Sanatorium,  Boulder,  Col. 

Glockner  Sanatorium,  Colorado  Springs,  Col. 

Star  Eanch  In-the-Pines  Sanatorium,  Col. 

Agnes  Memorial  Sanatorium,  Denver,  Col. 

Jewish  Consumptive  Relief  Soc.  Sanatorium,  Edgewater,  Col. 

Glenwood  Sanatorium,  Glenwood,  Col. 

Idaho  Springs  Sanatorium,  Idaho  Springs,  Col. 

Dr.  Friend's  Sanatorium,  Lamar,  Col. 

Montcalm  Sanatorium,  Manitou,  Col. 

Modern  Woodmen  Sanatorium,  Woodmen,  Col. 

Dr.  McFarland's  Sanatorium,  Greens  Farm,  Conn. 

Wildwood  Sanatorium,  Wildwood  Farms,  Hartford,  Conn. 

Dr.  Barnes  Sanatorium,  Stamford,  Conn. 

Dr.  Givens  Sanatorium,  Stamford,  Conn. 

Gaylord  Farm  Sanatorium,  Wallingford,  Conn. 

Westport  Sanatorium,  Westport,  Conn. 

National  Odd  Fellows  Sanatorium,  Gainesville,  Fla. 

De  Sota  Sanatorium,  Jacksonville,  Fla. 

Sanatorium  Centro  Espanol,  Tampa,  Fla. 

State  Sanatorium  for  Tuberculosis,  Alto,  Fla. 

Battle  Hill  Tuberculosis  Sanatorium,  Atlanta,  Ga. 

Davis-Fischer  Sanatorium,  Atlanta,  Ga. 

Pine  Mountain  Tuberculosis  Sanatorium,  Pinedale,  Ga. 

Rawlings  Sanatorium,  Sandersville,  Ga. 

Park  View  Sanatorium,  Savannah,  Ga. 

Fort  Lapwai  Indian  Sanatorium,  Lapwai,  Idaho. 

Haley  Sanatorium,  Champaign,  111. 

Garfield  Park  Sanatorium,  Chicago,  111. 

Parkhurst  Sanatorium,  Danvers,  111. 

Hinsdale  Sanatorium,  Hinsdale,  111. 

Oak  Lawn  Sanatorium,  Jacksonville,  HI. 


List  of  Sanatoriums.  207 

Edward  Sanatorium,  Naperville,  111. 

Sulphur  Springs  Sanatorium,  Peoria,  111. 

North  Shore  Health  Eesort,  Winnetka,  111. 

Neuronhurst,  Indianapolis,  Ind. 

Hunter  Mineral  Springs,  Kramer,  Ind. 

Mudlavia,  Kramer,  Ind. 

Brainard  Sanatorium,  Martinsville,  Ind. 

Colonial  Sanatorium,  Martinsville,  Ind. 

Highland  Mineral  Springs,  Martinsville,  Ind. 

Hill  House  Sanatorium,  Martinsville,  Ind. 

Home  Lawn  Mineral  Springs,  Martinsville,  Ind. 

Plymouth  Sanatorium,  Plymouth,  Ind. 

Kneipp  Sanatorium,  Eome  City,  Ind, 

Grand  Hotel  and  Sanatorium,  Colfax,  Iowa. 

Victoria  Sanatorium,  Colfax,  Iowa. 

Iowa  Sanatorium,  Nevad,  Iowa. 

Bonner  Springs  Lodge,  Bonner  Springs,  Kansas. 

Evergreen  Place  Sanatorium,  Leavenworth,  Kansas. 

Samaritan  Sanatorium,  Pittsburg,  Kansas. 

Euggles  Sanatorium,  Stafford,  Kansas. 

Kansas  Sanatorium,  "Wichita,  Kansas. 

New  Tenwick  Sanatorium,  Abbeville,  Louisiana. 

Baton  Eouge  Sanatorium,  Baton  Eouge,  Louisiana. 

Dr.  Ames  Tuberculosis  Sanatorium,  Shreveport,  Louisiana. 

Biedler  and  Selman  Sanatorium,  Baltimore,  Maryland. 

Eudowood  Sanatorium,  Baltimore,  Maryland. 

St.  Agnes  Sanatorium,  Baltimore,  Maryland. 

Laurel  Sanatorium,  Laurel,  Maryland. 

St.  Francis  Sanatorium,  Denville,  New  Jersey. 

Eiver  Lawn  Sanatorium,  Paterson,  New  Jersey, 

Brookside  Sanatorium,  Plainfield,  New  Jersey. 

Brunswick  Home,  Amityville,  New  York, 

Long  Island  Home,  Amityville,  New  York. 

Louden  Hall,  Amityville,  New  York, 

Eiver  Crest  Sanatorium,  Astoria,  New  York. 

Montefiore  Home  Country  Sanatorium,  Bedford,  New  York, 

Eoss  Health  Eesort,  Brentwood,  New  York. 

International  Sunshine  Sanatorium,  Brooklyn,  New  York. 

Day  Camp  for  Consumptives,  Buffalo,  New  York. 


208  Medicine  as  a  Pkofession. 

Castile  Sanatorium,  New  York. 

Clifton  Springs  Sanatorium,  Clifton  Springs,  New  York. 

Glenridge  Sanatorium,  Cranesville,  New  York. 

Jackson  Health  Resort,  Dansville,  New  York. 

Gleason  Health  Eesort,  Elmira,  New  York. 

Sanatorium  for  Hebrew  Children,  Far  Eockaway,  New  York. 

St.  Joseph's  Sanatorium,  Forrestburg,  New  York. 

Sanatorium  Gabriels,  Gabriels,  New  York. 

Interpines,  Goshen,  New  York. 

Steuben  Sanatorium,  Hornell,  New  York. 

Dr.  C.  C.  Sahler  Sanatorium,  Kingston,  New  York. 

Our  Lady  of  Victory  Sanatorium,  Kingston,  New  York. 

Adirondack  Sanatorium,  Lake  George,  New  York. 

Stony  Wold  Sanatorium,  Lake  Kushaqua,  New  York. 

Buckly  Sanatorium,  Liberty,  New  York. 

Workmen's  Circle  Sanatorium,  Liberty,  New  York. 

River  Crest  Sanatorium,  Island  City,  New  York. 

Loomis  Sanatorium,  Loomis,  New  York. 

Hudson  View  Sanatorium,  Nyack,  New  York. 

Glenmary  Sanatorium,  Owego,  New  York. 

Lake-Rainbow  Sanatorium,  Rainbow  Lake,  New  York. 

Graham  Sanatorium,  Rochester,  New  York. 

Dr.  Strong's  Sanatorium,  Saratoga  Springs,  New  York. 

Sheldrake  Springs  Sanatorium,  Sheldrake,  New  York. 

Marshall  Sanatorium,  Troy,  New  York. 

Adirondack    Cottage    Sanatorium,    Trudeau    (Saranac    Lake), 

New  York. 
Glen  Springs  Sanatorium,   Watkins,  New  York. 
Winyah  Sanatorium,  Asheville,  North  Carolina. 
Heidelberg  Sanatorium,  Flat  Rock,  North  Carolina. 
James  Sanatorium,  Laurinburg,  North  Carolina. 
Broadoaks  Sanatorium,  Morgantown,  North  Carolina. 
White-head-Stokes  Sanatorium,  Salisbury,  North  Carolina. 
Cincinnati  Sanatorium,  Cincinnati,  Ohio. 
Sawyer  Sanatorium,  ^Marion,  Ohio. 
Oxford  Retreat,  Oxford,  Ohio. 
Niles  Sanatorium,  Urbana,  Ohio. 
Radium  Springs,  Haines,  Oregon. 
Hot  Lake  Sanatorium,  Hot  Lake,  Oregon. 


List  op  Sanatoriums.  209 

Lakewood  Sanatorium,  Lakewood,  Oregon. 

Portland  Sanatorium,  Portland,  Oregon. 

Todd  Sanatorium,  Cambridge  Springs,  Pennsylvania. 

Philadelphia  Jewish  Sanatorium,  Eagleville,  Pennsylvania. 

Markleton  Sanatorium,  Markleton,  Pennsylvania. 

Mercer  Sanatorium,   Mercer,  Pennsylvania. 

East  End  Sanatorium,  Pittsburgh,  Pennsylvania. 

Mount  St.  Michael  Sanatorium,  Keading,  Pennsylvania. 

Fieldmore  Sanatorium,  Titusville,  Pennsylvania. 

Walter  Sanatorium,  Walters  Park,  Pennsylvania. 

Grand  View  Sanatorium,  Wernersville,  Pennsylvania. 

Sunnyrest  Sanatorium,  White  Haven,  Pennsylvania. 

White  Haven  Sanatorium,  White  Haven,  Pennsylvania. 

Dr.  Bate's  Sanatorium,  Providence,  Rhode  Island. 

Baker  Sanatorium,  Charleston,  South  Carolina. 

Chamberlain  Sanatorium,  Chamberlain,  South  Dakota. 

Dr.  Hargen's  Sanatorium,  Hot  Springs,  South  Dakota. 

Dr.  Nicholas  Sanatorium,  Hot  Springs,  South  Dakota. 

Drs.  Pettey  and  Wallace  Sanatorium,  Memphis,  Tenn. 

James  Sanatorium,  Memphis,  Tenn. 

City  View  Sanatorium,  Nashville,  Tenn. 

Grand  View  Sanatorium,  Newport,  Tenn. 

St.  Anthony's  Sanatorium,  Amarillo,  Texas. 

Austin  Presbyterian  Sanatorium,  Austin,  Texas. 

Austin  Sanatorium,  Austin,  Texas. 

Spohn  Sanatorium,  Corpus  Christi,  Texas. 

Dr.  W.  H.  Caldwell's  Sanatorium,  Cypress,  Texas. 

St.  Paul's  Sanatorium,  Dallas,  Texas. 

Doctor  Miller  Home  Sanatorium,  Dublin,  Texas. 

O'Brien's  Surgical  Sanatorium,  Dublin,  Texas. 

Arlington  Heights  Sanatorium,  Fort  Worth,  Texas. 

Baptist  Sanatorium,  Houston,  Texas. 

The  Heights  Sanatorium,  Houston,  Texas. 

Houston  Infirmary  Sanatorium,  Houston,  Texas. 

Hot  Well  Sanatorium,  Hubbard,  Texas. 

Torbett  Sanatorium,  Marlin,  Texas. 

St.  John's  Sanatorium,  San  Angelo,  Texas. 

Dr.  Moody's  Sanatorium,  San  Antonio,  Texas. 

St.  Vincents  Sanatorium,  Sherman,  Texas. 


210  Medicine  as  a  Peofession". 

Temple  Sanatorium,  Temple,  Texas. 

Providence  Sanatorium,  Waco,  Texas. 

Catawba  Sanatorium,  Catawba,  Virginia. 

Walton  Sanatorium,  Eichmond,  Virginia. 

Westbrook  Sanatorium,  Eichmond,  Virginia. 

Dr.  Allen's  Sanatorium,  Medical  Lake,  Washington. 

Cliff  Lodge  Sanatorium,  Port  Townsend,  Washington. 

Point  Pleasant,  Eaymond,  Washington. 

Firland  Sanatorium,  Seattle,  Washington. 

Siloam  Sanatorium,  Soap  Lake,  Washington. 

The  Sanatorium,  Hudson,  Wisconsin. 

Pennoyer  Sanatorium,  Kenosha,   W'^isconsin. 

Lake  Geneva  Sanatorium,  Lake  Grsneva,  Wisconsin. 

Madison  Sanatorium,  Madison,  Wisconsin. 

Eiverside  Sanatorium,  IMilwaukee,  Wisconsin. 

Sacred  Heart  Sanatorium,  Milwaukee,  Wisconsin. 

Oconomowoc  Health  Eesort,  Oconomowoc,  Wisconsin. 

Sanatorium  Waldheim,  Oconomowoc,  Wisconsin. 

Lakeside  Sanatorium,  Oshkosh,  Wisconsin. 

Waukesha  Springs  Sanatorium,  Waukesha,  Wisconsin. 

Milwaukee  Sanatorium,  Wauwatosa,  Wisconsin. 

Washakie  Sanatorium,  Thermopolis,  Wyoming. 

Eocky  Mountain  Sanatorium,  Frank,  Alberta. 

Halcyon  Hot  Springs,  Halcyon,  British  Columbia. 

Homewood  Sanatorium,  Guelph,  Ontario. 

Br.  de  Blois  Sanatorium,  Three  Eivers,  Quebec. 


INDEX 


Page 

Abilities,  Desirable  Native  12 
Admission  to  College,  Ee- 

quirements  for 51 

Aesculapius,   Disciples   of  1 

Agramonte,   Aristides    .  .  84 
Animal    Electricity,    Gal- 

vani    8 

Antitoxins    136 

Apothecary  shops,  First.  3 
Application  Form,  for  the 

Navy    72 

Aristotle    2 

Army  Service    37,  64 

Allowance    65 

Medical  Library    68 

Medical  Museum   68 

Pay    64 

Eetirement    66 

Requirements    66 

Auenbrugger,  Leopold,  11,  24 

Avicenna 3 

Barton,  Benjamin   7 

Bartlett,  Josiah 10 

Bernard,  Claude 11 

Bibliography 

Future  of  Medicine   .  .  192 

History    187 

Hospital    and    Labora- 
tory      190 

Medical  Education  ....  188 

Medical  Inspection   ...  190 

Medical   Missions    ....  191 

Medical  Research    ....  191 

Navy  and  Army   188 


Page 

Public  Health    189 

Systems  of  Medicine.  .   188 
Women  in  Medicine   .  .   191 

Bigelow,  Jacob    7 

Biological  Laboratories.  ,    139 

Boerhaave    5 

Brown,   John    8 

Brunfels,   Otto,  botanist.       7 

Canaday,   N.   F 79 

Canal  Zone 83 

Carrel,  Alexis    134 

Carroll,  James    84,     86 

Childrens '   Diseases    ....   144 

Child    Hygiene    101 

Code  of  Ethics    164 

Colleges,  Medical    196 

Commerce    and    Medicine  136 

Consultations     176,  177 

Cooke,  Robert  P 85,     86 

Corporation  Service   ..62,  125 
Duties  of  a  Physician 

as  a  Citizen   182 

to      Fellow      Practi- 
tioner     173,  175 

to    Patients    165 

to   Self    174 

Earnings    during    college 

vacation     25 

Earning     one's     way 

through    College    ...     26 
Earnings      in      medicine 

compared  with  law  .     29 

Ear  Specialist    142 

Eclectic  School    45 


211 


212 


Index. 


Page 

Emergencies    180 

Ethics,  a  Modern  Code  .  165 
Expense,  total  college    .  .     23 

Eye    Specialist    142 

Federal     Public     Health 

Service     90 

Fees  in  medical  colleges, 

22,  196 

Field,  Survey  of 57 

Financial  Eewards    28 

Finley,  Carlos    85 

Food  Inspection    101 

Fraternal  Societies  ....  62 
Future  of  Medicine   ....   151 

Galen 2 

Hall,   Lyman    10 

Harvey,    William    5 

Health  Service 

National    90 

State    96 

Municipal    98 

Hippocrates    1 

Hippocrates,  Oath  of  .  .  164 
History  of  medicine  ...  1 
History  of  1,000  medical 

students     20 

Holmes,  Oliver  Wendell  . .  8 
Homeopathic  School   ....     42 

Honorarium    173 

Hospital    ships    76 

Hospital   service    105 

Hospital,  number  of  ....    Ill 
Hunter,    John    and    Wil- 
liam           8 

Hygienic  laboratory  ....  94 
Indian  Service   stations  .   204 

Indian   Service    77 

Contract    physician  .     78 
Industrial  medicine    ....   178 


Page 
Insurance  examinations  .  128 
Ipecac,  Discovery  of  use     89 

Jenner    6 

Keats    8 

Laboratories,    biological  .   139 

Laboratory   work    112 

Salaries    113 

Laennec     5 

Laveran,  Alphonse   9 

Lazear,  Jesse  W 84 

Livingston,  David  9 

Location,  Selection  of   .  .     58 

Lodge  Practice    127 

Manufacturing   medicines  136 

Marine  hospitals   95 

Medical  College,    scholar- 
ships       200 

Medical  colleges  ....  51,  196 
Medical  College  Fees. 22,  196 
Medical    Inspection    of 

Schools    115 

Medical  Laws 157 

New  York 158 

Pennsylvania    161 

Summary     202 

Medical  Missions  . .  .  118,  124 
Medicine,  History  of  . .  .  1 
Medicine,  System  of  ...  .     39 

Metchnikof    134 

Missionary,  Medical,  118,  124 

Mitchell,  S.  Weir    8 

Montanus    5 

Muller,   Johannes    24 

Mullikin,  Clarence  W.   . .     79 

Naval   Service    37,     69 

Naval  Service,  Admission     71 

Personnel    75 

New    York    City    Public 

Health   System    99 


Index. 


213 


Page 
New    York   State    Public 

Health  Service 97 

Negro  Physicians   18 

Nose  Specialist    143 

Nostrums    172 

Number  of  Physicians, 

32,  193 
Oath,  Hippocratic  ......    164 

Oculist    142 

Olcott,  Oliver 10 

Orthopedic    surgery    ....   143 
Orthodoxy  in  medicine  . .   175 
Orders,    fraternal,    Prac- 
tice   for    127 

Osier,  "William   8 

Osteopathic  School   47 

Over-crowding,  Danger  of 

33,  34 

Pare,  Ambrose    9 

Patient's    duties    toward 

Physician    169 

Personnel,   Medical  Serv- 
ice of  Navy 75 

Personnel,      Changes      in 

Community    37 

Philippine  Service    87 

Philippine  Practice  ....  88 
Physician  in  Society  ....  7 
Physicians '    Opinions    of 

Medicine    35 

Physicians,  Number 

in  Cities    194 

in   States    193 

Protestant    Medical    Mis- 
sionaries        124 

Prospects    32 

Psychiatric  Institute,  pay  98 
Public  Health  Service  .  .  96 
Railway  Service    125 


Page 

Red    Cross    129 

Base  Hospital   129 

Ambulance  Corps    . .  130 

Reed  Commission    84 

Reed,  Walter   9 

Recognition    of   new    dis- 
coveries       6 

Regular  School    40 

Religio  Medici 8 

Residence  at  Y.  M.  C.  A.  15 

Research  Work    132 

Requirements   for    admis- 
sion      21 

Requirements 

for   Admission   to    Col- 
leges       51 

Financial   21 

for  Army    67 

for  Navy    73 

Rewards,    Financial    ....  28 
Rocky  Mountain  Spotted 

Fever    94 

Rockefeller    Institute,  133,  134 

Rural  practice   57 

Rush,   Benjamin    10 

Sanatoriums,  private    . . .  205 

Sanatoriums  service  ..62,  109 

Sanitary   Engineering    ,  .  83 

Canal  Zone   83 

Schwann,   Theodore    ....  8 
School  Physician  in  New 

York     117 

in  Prussia 116 

Scholarships    200 

School,    medical     Inspec- 
tion  of    115 

Simpson,  James 24 

Society,  the  physician  in  7 

Specialism    140 


214 


Index. 


■*^ 


Page 

Stegomyia    investigation .  85 

Steamship  service   127 

Superintendent,   hospital.  106 

Survey  of  the  Field 57 

Sylvius   5 

Systems: 

Eclectic    45 

Homeopathic    42 

Osteopathic   47 

Regular    40 

Tobler,  Titus   11 

Under-supplied    communi- 
ties     33 

Unlicensed    practitioners .  49 


Pa*:-   ui. 

U.     S.     Public      xiealth 

Service     90 

Personnel    91 

Foreign  stations   .  93 

Hospitals     95 

Pay    91 

Requirements    ....  92 

Vaccination,  smallpox    . .  6 

Vesalius 5 

Women  in  medicine  ...4,  146 
Workingmen  's     Compen- 
sation Laws   128 

Yellow  Fever  Commission  84 


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